Provider Demographics
NPI:1346099967
Name:MENDOZA, JUSTIN DANIEL
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DANIEL
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 N HARDING RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9277
Mailing Address - Country:US
Mailing Address - Phone:530-300-3373
Mailing Address - Fax:
Practice Address - Street 1:1526 PLUMAS CT STE 400
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2961
Practice Address - Country:US
Practice Address - Phone:530-443-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician