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NPI Code Detail

MEDICARE: JADE MENDOZA

MEDICARE: JADE 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
1101YM0800XMental Health Counselor
2101Y00000XCounselor
3171M00000XCase Manager/Care Coordinator
4390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1891196275
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE MENDOZA
Provider Business Mailing Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Provider Business Practice Location Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 10/17/2025

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