Provider Demographics
NPI:1700779824
Name:MENDOZA, IGNACIO III (PPS)
Entity type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:
Last Name:MENDOZA
Suffix:III
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 THAMES RIVER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5338
Mailing Address - Country:US
Mailing Address - Phone:805-981-1507
Mailing Address - Fax:
Practice Address - Street 1:3050 THAMES RIVER DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-5338
Practice Address - Country:US
Practice Address - Phone:805-981-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool