Provider Demographics
NPI:1932630720
Name:MENDOZA, JOYCELYN A (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:A
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2602
Mailing Address - Country:US
Mailing Address - Phone:831-678-2216
Mailing Address - Fax:831-678-1373
Practice Address - Street 1:355 GABILAN ST.
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-678-2216
Practice Address - Fax:831-678-1373
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA581347133V00000X
CA10521958174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN