Provider Demographics
NPI:1710498811
Name:MENDOZA, CELENE MARIE (INTAKE SPECIALIST)
Entity Type:Individual
Prefix:
First Name:CELENE
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:INTAKE SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-1449
Mailing Address - Country:US
Mailing Address - Phone:707-472-0350
Mailing Address - Fax:707-472-0358
Practice Address - Street 1:350 E GOBBI ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5511
Practice Address - Country:US
Practice Address - Phone:707-467-2010
Practice Address - Fax:707-467-2010
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator