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NPI Code Detail

MEDICARE: NATANEMARIE MENDOZA

MEDICARE: NATANEMARIE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1972080794
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATANEMARIE MENDOZA
Provider Business Mailing Address
First Line : 18726 S WESTERN AVE STE 408
Second Line :
City : GARDENA
State : CA
Zip : 90248-3858
Country : US
Telephone Number : 310-856-0800
Fax Number : 855-568-2494
Provider Business Practice Location Address
First Line : 27349 JEFFERSON AVE STE 204
Second Line :
City : TEMECULA
State : CA
Zip : 92590-5612
Country : US
Telephone Number : 951-466-3032
Fax Number : 855-568-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2018
Last Update Date : 05/28/2021

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Directions to “ NATANEMARIE MENDOZA ” Practice Location

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