Healthcare Provider Details

I. General information

NPI: 1720337363
Provider Name (Legal Business Name): CINDY MENDOZA-LOPEZ ASW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WATER ST STE B
SANTA CRUZ CA
95060-2792
US

IV. Provider business mailing address

125 WATER ST STE B
SANTA CRUZ CA
95060-2792
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: