MEDICARE: CRYSTAL MENDOZA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1417767880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MENDOZA

Provider Business Mailing Address
First Line	:	1500 E HAMILTON AVE STE 105
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-0834
Country	:	US
Telephone Number	:	408-408-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 BRADFORD ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1727
Country	:	US
Telephone Number	:	650-482-2200
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2026

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Directions to “ CRYSTAL MENDOZA ” Practice Location

Language	Start Address	Practice Location

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