Provider Demographics
NPI:1356634521
Name:MENDONZA, CYNTHIA C (MS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:MENDONZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 PARK DR STE 20-451
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4549
Mailing Address - Country:US
Mailing Address - Phone:916-765-0504
Mailing Address - Fax:
Practice Address - Street 1:3941 PARK DR STE 20-451
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4549
Practice Address - Country:US
Practice Address - Phone:916-765-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-6796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst