Provider Demographics
NPI:1710522669
Name:MANDUJANO, MARIA (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MANDUJANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 UNIVERSITY AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-1149
Mailing Address - Country:US
Mailing Address - Phone:831-756-5567
Mailing Address - Fax:
Practice Address - Street 1:921 UNIVERSITY AVE APT 19
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-1149
Practice Address - Country:US
Practice Address - Phone:831-756-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst