Healthcare Provider Details

I. General information

NPI: 1275323370
Provider Name (Legal Business Name): RICHARD MENDOZA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W BRADLEY PL STE 100
CHICAGO IL
60618-4716
US

IV. Provider business mailing address

4953 N BELL AVE APT 3
CHICAGO IL
60625-6849
US

V. Phone/Fax

Practice location:
  • Phone: 877-552-6672
  • Fax:
Mailing address:
  • Phone: 562-833-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: