Provider Demographics
NPI:1780141820
Name:MENDOZA, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NEPONSET AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3169
Mailing Address - Country:US
Mailing Address - Phone:857-217-3700
Mailing Address - Fax:
Practice Address - Street 1:3187 AIRWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4603
Practice Address - Country:US
Practice Address - Phone:714-881-0427
Practice Address - Fax:714-327-0673
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2024-09-03
Deactivation Date:2024-07-24
Deactivation Code:
Reactivation Date:2024-09-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst