Provider Demographics
NPI:1629441639
Name:MENDOZA-MIRANDA, JESSICA LISBET
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LISBET
Last Name:MENDOZA-MIRANDA
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 1:595 BUCKINGHAM WAY STE 343
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1911
Mailing Address - Country:US
Mailing Address - Phone:510-756-0810
Mailing Address - Fax:
Practice Address - Street 1:55 SANTA CLARA AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1319
Practice Address - Country:US
Practice Address - Phone:510-756-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor