Healthcare Provider Details

I. General information

NPI: 1124951884
Provider Name (Legal Business Name): JACINTA MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 W LINNE RD STE J-9
TRACY CA
95377-8024
US

IV. Provider business mailing address

1226 PARKER AVE
TRACY CA
95376-3520
US

V. Phone/Fax

Practice location:
  • Phone: 209-340-9374
  • Fax:
Mailing address:
  • Phone: 209-834-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA10202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: