Provider Demographics
NPI:1790495497
Name:MENDOZA, ADRIAN MOLINERO (AMFT 133436)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MOLINERO
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:AMFT 133436
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2174
Mailing Address - Country:US
Mailing Address - Phone:310-752-1324
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2174
Practice Address - Country:US
Practice Address - Phone:310-752-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist