MEDICARE: ALEXIS CAMILLE MENDOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	66672	CA

General Provider Information

NPI Number	:	1427757244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS CAMILLE MENDOZA

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3411
Country	:	US
Telephone Number	:	310-342-2592
Fax Number	:	310-324-3947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	01/01/2026

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Directions to “ ALEXIS CAMILLE MENDOZA ” Practice Location

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