Provider Demographics
NPI:1942052311
Name:MENDOZA, ELLEN KONG (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:KONG
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31544 FOX GRAPE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9477
Mailing Address - Country:US
Mailing Address - Phone:323-605-7038
Mailing Address - Fax:
Practice Address - Street 1:31544 FOX GRAPE DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9477
Practice Address - Country:US
Practice Address - Phone:323-605-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7798103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst