Provider Demographics
NPI:1902409493
Name:MENDOZA HURTADO, CRYSTAL DIANNA (LCSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DIANNA
Last Name:MENDOZA HURTADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DIANNA
Other - Last Name:HURTADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 E PACIFIC COAST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3233
Mailing Address - Country:US
Mailing Address - Phone:562-344-1140
Mailing Address - Fax:
Practice Address - Street 1:4500 E PACIFIC COAST HWY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3233
Practice Address - Country:US
Practice Address - Phone:562-344-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98041101YM0800X, 104100000X
CALCSW1188031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker