MEDICARE: CECILIA MENDEZ LMFT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	127616	CA

General Provider Information

NPI Number	:	1184990970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA MENDEZ LMFT

Provider Business Mailing Address
First Line	:	2550 CANYON SPRINGS PKWY STE I
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0951
Country	:	US
Telephone Number	:	951-444-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	#1016 2550 CANYON SPRINGS PKWY
Second Line	:	SUITE I
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0961
Country	:	US
Telephone Number	:	951-444-8828
Fax Number	:

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

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	08/25/2022

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