Healthcare Provider Details

I. General information

NPI: 1164984803
Provider Name (Legal Business Name): ALAN ALEJANDRO MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12464 RANCHO VISTA DR
CERRITOS CA
90703-1855
US

IV. Provider business mailing address

2021 MAINE AVE
LONG BEACH CA
90806-4130
US

V. Phone/Fax

Practice location:
  • Phone: 562-537-1121
  • Fax:
Mailing address:
  • Phone: 562-537-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: