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General NPI Number Information
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NPI Number | 1649632480
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Entity Type | Individual
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Provider Name | JASMINE MENDOZA BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 1485 SARATOGA AVE STE 100
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City | SAN JOSE
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State | CA
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Zip | 95129-4965
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Country | US
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Telephone | 818-241-6780
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Fax | 818-241-6853
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Provider Business Mailing Address
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Address Line | PO BOX 767938
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City | ROSWELL
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State | GA
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Zip | 30076-7938
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Country | US
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Telephone | 818-241-6780
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Fax | 818-241-6853
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-40636
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License Number State | CA
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