Active NPI
Irvin Mendoza
- Behavior Technician
- Yakima, WA
National Provider Identifier
1851951735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- CB60975512
- Practice address
- 5201 Tieton Dr
Yakima, WA 98908-3485 - Phone
- (509) 965-7100
- NPI assigned
- Jun 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CB60975512 | WA | Primary |
Addresses
Primary practice location
5201 Tieton Dr
Yakima, WA 98908-3485
Mailing address
5201 Tieton Dr Ste C
Yakima, WA 98908-3485
Phone (509) 965-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CB60975512 | WA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560384000000",
"number": "1851951735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5201 TIETON DR STE C",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989083485",
"telephone_number": "509-965-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5201 TIETON DR",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989083485",
"telephone_number": "509-965-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "IRVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-13",
"last_updated": "2019-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "WA",
"license": "CB60975512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.