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General NPI Number Information
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NPI Number | 1467625863
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Entity Type | Individual
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Provider Name | IKE MENDOZA LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 10927 DOWNEY AVE STE C
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City | DOWNEY
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State | CA
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Zip | 90241
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Country | US
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Telephone | 562-861-6180
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Fax | 951-694-0553
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Provider Business Mailing Address
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Address Line | P.O. BOX 2435
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City | TEMECULA
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State | CA
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Zip | 92593-2435
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Country | US
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Telephone | 951-676-4393
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Fax | 951-694-0553
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 22445
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License Number State | CA
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