Provider Demographics
NPI:1205901931
Name:MEXICAN AMERICAN COMMUNITY SERVICES AGENCY, INC.
Entity type:Organization
Organization Name:MEXICAN AMERICAN COMMUNITY SERVICES AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXCUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:SOSA
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-928-1122
Mailing Address - Street 1:130 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1907
Mailing Address - Country:US
Mailing Address - Phone:408-928-1155
Mailing Address - Fax:408-928-1153
Practice Address - Street 1:130 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1907
Practice Address - Country:US
Practice Address - Phone:408-928-1155
Practice Address - Fax:408-928-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70050FMedicaid