Basic Information
| Provider Information | |||||||||
| NPI: | 1033649215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | CORINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4849 RONSON CT STE 207 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921111805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447373638 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8337 TELEGRAPH RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906604957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628653644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2017 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | CA | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | AMFT112162 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.