Healthcare Provider Details

I. General information

NPI: 1083459705
Provider Name (Legal Business Name): JAZLIN TESS MENDOZA BALDOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 AUPUNI ST APT 804
HONOLULU HI
96817-2063
US

IV. Provider business mailing address

2001 AUPUNI ST APT 804
HONOLULU HI
96817-2063
US

V. Phone/Fax

Practice location:
  • Phone: 408-818-0577
  • Fax:
Mailing address:
  • Phone: 408-818-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: