MEDICARE: JACQUELINE ESMERALDA MENDEZ

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	158749	CA
2	101YP2500X	Professional Counselor	20838	CA

General Provider Information

NPI Number	:	1316806706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ESMERALDA MENDEZ

Provider Business Mailing Address
First Line	:	8750 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8750 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4830
Country	:	US
Telephone Number	:	323-593-5300
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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