Provider Demographics
NPI:1548989460
Name:MENDOZA, MARIA ELENA (SLPA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3066
Mailing Address - Country:US
Mailing Address - Phone:209-808-9199
Mailing Address - Fax:
Practice Address - Street 1:2516 VERNE ROBERTS CIR STE H102
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-7918
Practice Address - Country:US
Practice Address - Phone:925-350-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant