Provider Demographics
NPI:1285004671
Name:MENDOZA, CHRISTINA NANNETTE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NANNETTE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SW 201ST AVE
Mailing Address - Street 2:204
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1203
Mailing Address - Country:US
Mailing Address - Phone:619-453-8109
Mailing Address - Fax:
Practice Address - Street 1:1411 SW MORRISTON STREET
Practice Address - Street 2:310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-352-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health