Provider Demographics
NPI:1316761752
Name:MENDOZA NAVA, MONICA FERNANDA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:FERNANDA
Last Name:MENDOZA NAVA
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 1:6441 MONTECITO BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2933
Mailing Address - Country:US
Mailing Address - Phone:707-484-3580
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 104
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:CA
Practice Address - Zip Code:95439-0104
Practice Address - Country:US
Practice Address - Phone:707-303-6266
Practice Address - Fax:707-615-7787
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician