Healthcare Provider Details

I. General information

NPI: 1699601153
Provider Name (Legal Business Name): DESTINY D MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N ELM AVE
PASCO WA
99301-5902
US

IV. Provider business mailing address

3703 W KENNEWICK AVE APT C321
KENNEWICK WA
99336-4279
US

V. Phone/Fax

Practice location:
  • Phone: 509-845-7118
  • Fax:
Mailing address:
  • Phone: 509-845-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: