Provider Demographics
NPI:1164838090
Name:TOMISTA, JUNNEL JANICE MENDOZA (LMFT, ET/P)
Entity Type:Individual
Prefix:MS
First Name:JUNNEL JANICE
Middle Name:MENDOZA
Last Name:TOMISTA
Suffix:
Gender:F
Credentials:LMFT, ET/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 W 3RD ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4318
Mailing Address - Country:US
Mailing Address - Phone:310-994-2008
Mailing Address - Fax:
Practice Address - Street 1:8075 W 3RD ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4318
Practice Address - Country:US
Practice Address - Phone:310-994-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist