Provider Demographics
NPI:1336329416
Name:MENDOZA, LUCINDA NOEMI
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:NOEMI
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 BIDWELL LN
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5829
Mailing Address - Country:US
Mailing Address - Phone:951-858-9973
Mailing Address - Fax:
Practice Address - Street 1:1612 1ST ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1407
Practice Address - Country:US
Practice Address - Phone:760-398-9000
Practice Address - Fax:760-398-9790
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA985471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor