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General NPI Number Information
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NPI Number | 1154833903
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Entity Type | Individual
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Provider Name | CRYSTAL RIVERA MENENDEZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 21682 SHADYSPRING RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-6838
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Country | US
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Telephone | 510-424-7693
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 MITCHELL LN
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City | MANTECA
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State | CA
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Zip | 95336-4125
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Country | US
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Telephone | 209-679-1087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85996
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License Number State | CA
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