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General NPI Number Information
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NPI Number | 1265752703
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Entity Type | Organization
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Legal Business Name | COMPASS CHRISTIAN PSYCHOLOGISTS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 10/23/2015
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Provider Practice Location Address
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Address Line | 1272 CENTER COURT DR 103
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City | COVINA
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State | CA
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Zip | 91724-3667
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Country | US
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Telephone | 951-310-1159
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Fax | 626-387-8095
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | WALNUT
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State | CA
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Zip | 91788-0553
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Country | US
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Telephone | 951-310-1159
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CHARLES MENDOZA
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Credential | PHD.
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Telephone | 951-310-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 19399
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License Number State | CA
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