Individual
SAN JUANA MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.ED.S.
Contact information
Practice address
1453 N. MAIN STREET, SUITE F, SAL LUIS, AZ 85349
(928) 627-3635
(928) 722-7025
Mailing address
2968 S BROKEN ARROW LN, YUMA, AZ 85364-7447
(928) 344-8096
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
333061
AHCCS
AZ
Enumeration date
03/08/2007
Last updated
07/08/2007
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