Provider Demographics
NPI:1588354435
Name:MENDEZ, MARIA LUPITA (DAC I)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUPITA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:DAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 WALNUT ST STE G
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3611
Mailing Address - Country:US
Mailing Address - Phone:530-527-8491
Mailing Address - Fax:530-527-0766
Practice Address - Street 1:1850 WALNUT ST STE G
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3611
Practice Address - Country:US
Practice Address - Phone:530-855-0421
Practice Address - Fax:530-527-0766
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)