Provider Demographics
NPI:1194569699
Name:LOPEZ MENDOZA, SANDY JACQUILIN
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:JACQUILIN
Last Name:LOPEZ MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 BERKSFORD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4607
Mailing Address - Country:US
Mailing Address - Phone:408-479-0826
Mailing Address - Fax:
Practice Address - Street 1:1542 BERKSFORD WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4607
Practice Address - Country:US
Practice Address - Phone:408-479-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician