Provider Demographics
NPI:1396274700
Name:CRUZ MENDOZA, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:CRUZ 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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-0126
Mailing Address - Country:US
Mailing Address - Phone:818-571-0924
Mailing Address - Fax:
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2622
Practice Address - Country:US
Practice Address - Phone:818-571-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109114106H00000X
390200000X
CA151359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program