Provider Demographics
NPI:1699826107
Name:MENDOZA, ELIZABETH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 MINNESOTA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2451
Mailing Address - Country:US
Mailing Address - Phone:408-448-7148
Mailing Address - Fax:
Practice Address - Street 1:1055 MINNESOTA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2451
Practice Address - Country:US
Practice Address - Phone:408-448-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health