Provider Demographics
NPI:1376676536
Name:LEMUS MENDEZ, DOLORES REBECA
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:REBECA
Last Name:LEMUS MENDEZ
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 1:4525 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3530
Mailing Address - Country:US
Mailing Address - Phone:408-558-5460
Mailing Address - Fax:408-558-5571
Practice Address - Street 1:4525 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3530
Practice Address - Country:US
Practice Address - Phone:408-558-5460
Practice Address - Fax:408-558-5571
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health