Provider Demographics
NPI:1255037727
Name:MENDOZA, ELEUTERIO VINCULADO JR
Entity type:Individual
Prefix:DR
First Name:ELEUTERIO
Middle Name:VINCULADO
Last Name:MENDOZA
Suffix:JR
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 1:455 SILICON VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1858
Mailing Address - Country:US
Mailing Address - Phone:669-234-5959
Mailing Address - Fax:
Practice Address - Street 1:455 SILICON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1858
Practice Address - Country:US
Practice Address - Phone:669-234-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33799103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist