Provider Demographics
NPI:1659161867
Name:MENDOZA SANDOVAL, NICOLE PILAR
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PILAR
Last Name:MENDOZA SANDOVAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 LINDLEY AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3240
Mailing Address - Country:US
Mailing Address - Phone:818-863-0005
Mailing Address - Fax:
Practice Address - Street 1:3210 W BURBANK BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2200
Practice Address - Country:US
Practice Address - Phone:818-638-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician