Provider Demographics
NPI:1629117676
Name:MOSQUEDA, WENDY ALICIA (MFT - 1)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ALICIA
Last Name:MOSQUEDA
Suffix:
Gender:F
Credentials:MFT - 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-8000
Mailing Address - Country:US
Mailing Address - Phone:408-528-5886
Mailing Address - Fax:
Practice Address - Street 1:650 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2601
Practice Address - Country:US
Practice Address - Phone:408-793-5870
Practice Address - Fax:408-275-6716
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 48803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist