Healthcare Provider Details

I. General information

NPI: 1558141036
Provider Name (Legal Business Name): CYNTHIA L MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 E ALBERTONI ST STE 100
CARSON CA
90746-1538
US

IV. Provider business mailing address

649 E ALBERTONI ST STE 100
CARSON CA
90746-1538
US

V. Phone/Fax

Practice location:
  • Phone: 310-436-9300
  • Fax:
Mailing address:
  • Phone: 310-436-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: