Healthcare Provider Details

I. General information

NPI: 1902092745
Provider Name (Legal Business Name): JAIME ALBERTO MENDOZA JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LAS GALLINAS AVE
SAN RAFAEL CA
94903-1843
US

IV. Provider business mailing address

1111 LAS GALLINAS AVE
SAN RAFAEL CA
94903-1843
US

V. Phone/Fax

Practice location:
  • Phone: 415-491-0581
  • Fax:
Mailing address:
  • Phone: 415-491-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number250140902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: