Provider Demographics
NPI:1205158235
Name:MENDOZA, SUSAN MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 S TUSTIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3348
Mailing Address - Country:US
Mailing Address - Phone:714-289-1418
Mailing Address - Fax:714-782-7424
Practice Address - Street 1:681 S TUSTIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3348
Practice Address - Country:US
Practice Address - Phone:714-289-1418
Practice Address - Fax:714-782-7424
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist