Basic Information
| Provider Information | |||||||||
| NPI: | 1962839902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | MIRELLA | ||||||||
| MiddleName: | RANGEL | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666824842 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 847 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666824842 | ||||||||
| FaxNumber: | 8774361488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2013 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 100451 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.