Provider Demographics
NPI:1760252902
Name:MENDOZA, JONATHAN CANTORNA (BA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CANTORNA
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:CANTORNA
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:214 WAIANUENUE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2489
Mailing Address - Country:US
Mailing Address - Phone:808-961-7016
Mailing Address - Fax:
Practice Address - Street 1:214 WAIANUENUE AVE STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2489
Practice Address - Country:US
Practice Address - Phone:808-961-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician