Provider Demographics
NPI:1720962178
Name:MENDOZA PEREZ, DIEGO ERNESTO SR
Entity type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:ERNESTO
Last Name:MENDOZA PEREZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 KAINS AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2208
Mailing Address - Country:US
Mailing Address - Phone:341-242-3541
Mailing Address - Fax:
Practice Address - Street 1:509 PARKER AVE
Practice Address - Street 2:
Practice Address - City:RODEO
Practice Address - State:CA
Practice Address - Zip Code:94572-1432
Practice Address - Country:US
Practice Address - Phone:510-501-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician