Provider Demographics
NPI:1891272985
Name:MENDEZ, AMY ALLISON
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ALLISON
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5378
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:CA
Mailing Address - Zip Code:92386-5378
Mailing Address - Country:US
Mailing Address - Phone:909-938-9837
Mailing Address - Fax:
Practice Address - Street 1:41945 BIG BEAR BLVD
Practice Address - Street 2:223
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-878-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst