Healthcare Provider Details

I. General information

NPI: 1023934494
Provider Name (Legal Business Name): ELENA KRYSTAL MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLUMAS ST STE 1200
YUBA CITY CA
95991-3490
US

IV. Provider business mailing address

761 PLUMAS ST UNIT 933
YUBA CITY CA
95992-2140
US

V. Phone/Fax

Practice location:
  • Phone: 530-763-2176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: