Healthcare Provider Details

I. General information

NPI: 1417278706
Provider Name (Legal Business Name): GINA MENDEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28581 OLD TOWN FRONT ST STE 201
TEMECULA CA
92590-2724
US

IV. Provider business mailing address

42947 BEAMER CT
TEMECULA CA
92592-6625
US

V. Phone/Fax

Practice location:
  • Phone: 951-399-2810
  • Fax: 909-363-9255
Mailing address:
  • Phone: 951-855-4967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9774-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: