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General NPI Number Information
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NPI Number | 1508632845
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Entity Type | Individual
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Provider Name | MATTHEW GARCIA MENDOZA BCBA
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Gender | Male
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4250 SUNRISE HWY STE 206
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5344
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Country | US
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Telephone | 516-324-6380
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Fax |
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Provider Business Mailing Address
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Address Line | 4752 N OPAL AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-4406
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Country | US
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Telephone | 630-209-0268
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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 | 1-23-69848
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License Number State | IL
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