Provider Demographics
NPI:1790840064
Name:MENDOZA, MARIA ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19730 SAND SPRING DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3238
Mailing Address - Country:US
Mailing Address - Phone:909-595-1687
Mailing Address - Fax:
Practice Address - Street 1:1274 CENTER COURT DR
Practice Address - Street 2:SUITE 112
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3668
Practice Address - Country:US
Practice Address - Phone:626-915-1681
Practice Address - Fax:626-915-6503
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS014980OtherCHILDREN'S MEDICAL SERVIC