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Individual

IZAAC VICTOR MENDOZA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BA

Contact information

Practice address
200 PATRICK BLVD SUITE 250, BROOKFIELD, WI 53045
(888) 754-0398
Mailing address
4590 S 20TH ST APT 4, MILWAUKEE, WI 53221-5307
(773) 558-9363

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary

Other

Enumeration date
06/05/2023
Last updated
06/05/2023
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