Provider Demographics
NPI:1528251600
Name:MENDEZ, EBONY
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40284 ROAD 40
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9775
Mailing Address - Country:US
Mailing Address - Phone:559-897-5367
Mailing Address - Fax:
Practice Address - Street 1:114 E SHAW AVE STE 210
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7621
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:559-221-8101
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)