Provider Demographics
NPI:1093377889
Name:MENDOZA, RODRIGO ESTEBAN (BEH-000429)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:ESTEBAN
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:BEH-000429
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 W SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5020
Mailing Address - Country:US
Mailing Address - Phone:602-405-8016
Mailing Address - Fax:
Practice Address - Street 1:6916 W SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5020
Practice Address - Country:US
Practice Address - Phone:602-405-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000429103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst