Basic Information
| Provider Information | |||||||||
| NPI: | 1922213172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | BERNEDETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7232 CANBY ST | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055561 | ||||||||
| FaxNumber: | 8187058248 | ||||||||
| Practice Location | |||||||||
| Address1: | 7232 CANBY AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913353006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055561 | ||||||||
| FaxNumber: | 8187058248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.