Provider Demographics
NPI:1851596522
Name:MENDEZ, JESSE III
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:MENDEZ
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 N MILLBROOK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1459
Mailing Address - Country:US
Mailing Address - Phone:559-241-0364
Mailing Address - Fax:559-221-4336
Practice Address - Street 1:3152 N MILLBROOK AVE STE D
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-341-0364
Practice Address - Fax:559-341-0342
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health