Healthcare Provider Details

I. General information

NPI: 1659763324
Provider Name (Legal Business Name): KATIE MENDOZA BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD
WALNUT CREEK CA
94597-7746
US

IV. Provider business mailing address

4246 MILL CREEK ST
RIVERSIDE CA
92509
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: