Provider Demographics
NPI:1548772163
Name:MENDOZA, JOHN ANTHONY (AMFT 132638)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:AMFT 132638
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1906
Mailing Address - Country:US
Mailing Address - Phone:951-407-8811
Mailing Address - Fax:
Practice Address - Street 1:1484 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1906
Practice Address - Country:US
Practice Address - Phone:951-407-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132638101YM0800X
CAIMF92067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health