Provider Demographics
NPI:1083089445
Name:NARCISO MENDEZ, RIGOBERTO
Entity Type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:
Last Name:NARCISO MENDEZ
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 1:154A CAPP ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1210
Mailing Address - Country:US
Mailing Address - Phone:415-826-6767
Mailing Address - Fax:145-826-6774
Practice Address - Street 1:154A CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1210
Practice Address - Country:US
Practice Address - Phone:415-826-6767
Practice Address - Fax:145-826-6774
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA380008AN174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA380008BNOtherFDT STATE CERTIFICATE