Healthcare Provider Details

I. General information

NPI: 1578299830
Provider Name (Legal Business Name): ANGELA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 3400
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

849 E MAGNESIUM RD APT I308
SPOKANE WA
99208-6973
US

V. Phone/Fax

Practice location:
  • Phone: 509-900-3669
  • Fax:
Mailing address:
  • Phone: 701-330-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61507348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: