Provider Demographics
NPI:1295424182
Name:MENDOZA MARISCAL, CELESTINA
Entity type:Individual
Prefix:
First Name:CELESTINA
Middle Name:
Last Name:MENDOZA MARISCAL
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 1:390 UNION BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:800-465-3203
Mailing Address - Fax:720-307-5501
Practice Address - Street 1:11698 N. HURON ST.
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:720-307-5501
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician