=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295528511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA MENDOZA PPSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10643 AVENUE 416
-----------------------------------------------------
City | SULTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93666-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-591-1634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12623 AVENUE 416
-----------------------------------------------------
City | OROSI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93647-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-528-4763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 210067500
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------