MEDICARE: ROSARIO MENDOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	390200000X	Student in an Organized Health Care Education/Training Program
2	171M00000X	Case Manager/Care Coordinator
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1124543525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSARIO MENDOZA

Provider Business Mailing Address
First Line	:	43520 DIVISION ST
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4089
Country	:	US
Telephone Number	:	661-492-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	8399 TOPANGA CANYON BLVD STE 303
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2354
Country	:	US
Telephone Number	:	818-593-4246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	04/29/2022

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Directions to “ ROSARIO MENDOZA ” Practice Location

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