Provider Demographics
NPI:1730916081
Name:MENDOZA, CRYSTAL D
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:MENDOZA
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 1:30 GLADDEN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1517
Mailing Address - Country:US
Mailing Address - Phone:959-888-1182
Mailing Address - Fax:
Practice Address - Street 1:30 GLADDEN ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1517
Practice Address - Country:US
Practice Address - Phone:959-888-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician