Provider Demographics
NPI:1023115185
Name:MENDOZA, GARY PAUL (MA, LMFT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PAUL
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2830
Mailing Address - Country:US
Mailing Address - Phone:714-679-1635
Mailing Address - Fax:714-505-6097
Practice Address - Street 1:5212 KATELLA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2830
Practice Address - Country:US
Practice Address - Phone:714-679-1635
Practice Address - Fax:714-505-6097
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist