Healthcare Provider Details

I. General information

NPI: 1215866462
Provider Name (Legal Business Name): JUAN CARLOS MENDEZ LCSW, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 W MCFADDEN AVE
SANTA ANA CA
92704-1142
US

IV. Provider business mailing address

4600 W MCFADDEN AVE
SANTA ANA CA
92704-1142
US

V. Phone/Fax

Practice location:
  • Phone: 714-663-6615
  • Fax:
Mailing address:
  • Phone: 714-663-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: