Provider Demographics
NPI:1932407624
Name:VITE, DENISE MENDOZA
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MENDOZA
Last Name:VITE
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 1:3432 E WHITE CHAPEL CT
Mailing Address - Street 2:UNIT F
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-7518
Mailing Address - Country:US
Mailing Address - Phone:714-420-2855
Mailing Address - Fax:
Practice Address - Street 1:2055 KELLOGG AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3111
Practice Address - Country:US
Practice Address - Phone:951-898-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical