Provider Demographics
NPI:1750736419
Name:MENDOZA GUTIERREZ, GEORGINA (MSW)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:MENDOZA GUTIERREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S BRAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3550
Mailing Address - Country:US
Mailing Address - Phone:818-231-9992
Mailing Address - Fax:
Practice Address - Street 1:1800 S BRAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3550
Practice Address - Country:US
Practice Address - Phone:818-231-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC605797381041C0700X
CA863071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical