Provider Demographics
NPI:1083138333
Name:MENDEZ, LUIS DANIEL (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:DANIEL
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11241 MARTHA ANN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2917
Mailing Address - Country:US
Mailing Address - Phone:562-881-1023
Mailing Address - Fax:562-429-2365
Practice Address - Street 1:3472 TULANE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2654
Practice Address - Country:US
Practice Address - Phone:310-529-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760911184OtherNPI