MEDICARE: DESTINY MIRANDA 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	:	1982550125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY MIRANDA MENDOZA

Provider Business Mailing Address
First Line	:	31 RANCHO CAMINO DR
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-7030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9515 54TH ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-3712
Country	:	US
Telephone Number	:	951-536-7014
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ DESTINY MIRANDA MENDOZA ” Practice Location

Language	Start Address	Practice Location

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