Provider Demographics
NPI:1740697481
Name:MENDOZA, VIVIAN A (BA, MED)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:A
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 GROFFS MILL DR
Mailing Address - Street 2:STE 766
Mailing Address - City:OWNING MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-216-1499
Mailing Address - Fax:
Practice Address - Street 1:9722 GROFFS MILL DR
Practice Address - Street 2:STE 766
Practice Address - City:OWNING MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-205-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician