Provider Demographics
NPI:1376056457
Name:MENDOZA, CECILIA C (BA, RBT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:C
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 DESERT WILLOW LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7533
Mailing Address - Country:US
Mailing Address - Phone:951-415-8456
Mailing Address - Fax:
Practice Address - Street 1:1180 DESERT WILLOW LN UNIT C
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7533
Practice Address - Country:US
Practice Address - Phone:951-415-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-40839106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician