Healthcare Provider Details

I. General information

NPI: 1396656856
Provider Name (Legal Business Name): ANGELICA CHAVEZ MENCIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 FOOTHILL BLVD
SAN LEANDRO CA
94578-1013
US

IV. Provider business mailing address

27458 CAPRI AVE
HAYWARD CA
94545-4002
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-9690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: