Provider Demographics
NPI:1083459705
Name:BALDOZ, JAZLIN TESS MENDOZA
Entity type:Individual
Prefix:
First Name:JAZLIN TESS
Middle Name:MENDOZA
Last Name:BALDOZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 AUPUNI ST APT 804
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2063
Mailing Address - Country:US
Mailing Address - Phone:408-818-0577
Mailing Address - Fax:
Practice Address - Street 1:2001 AUPUNI ST APT 804
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2063
Practice Address - Country:US
Practice Address - Phone:408-818-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool