Provider Demographics
NPI:1033703442
Name:GONZALEZ-MENDOZA, HUMBERTO EMILIO
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:EMILIO
Last Name:GONZALEZ-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:VYFS - 20110 VASHON HWY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070
Mailing Address - Country:US
Mailing Address - Phone:206-463-5511
Mailing Address - Fax:
Practice Address - Street 1:25507 75TH AVE SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-7937
Practice Address - Country:US
Practice Address - Phone:425-351-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61124285101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor