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General NPI Number Information
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NPI Number | 1275186629
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Entity Type | Individual
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Provider Name | VANESSA MENDOZA
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 11731 TELEGRAPH RD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-3675
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Country | US
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Telephone | 562-942-8256
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Fax |
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Provider Business Mailing Address
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Address Line | 11331 183RD ST # 169
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City | CERRITOS
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State | CA
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Zip | 90703-5434
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | AMFT130638
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT130638
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT147284
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License Number State | CA
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