Provider Demographics
NPI:1457718074
Name:CARRAZCO MENDOZA, SAYRA YANET
Entity Type:Individual
Prefix:MS
First Name:SAYRA
Middle Name:YANET
Last Name:CARRAZCO MENDOZA
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 1:17053 FOOTHILL BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3574
Mailing Address - Country:US
Mailing Address - Phone:909-347-1300
Mailing Address - Fax:909-347-1302
Practice Address - Street 1:17053 FOOTHILL BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3574
Practice Address - Country:US
Practice Address - Phone:909-347-1300
Practice Address - Fax:909-347-1302
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61915104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker