Provider Demographics
NPI:1649751207
Name:MENDOZA, CASSANDRA (SLPA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 GIFFORD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-3456
Mailing Address - Country:US
Mailing Address - Phone:323-907-9463
Mailing Address - Fax:
Practice Address - Street 1:555 W COMPTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3099
Practice Address - Country:US
Practice Address - Phone:310-637-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6069103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent