Healthcare Provider Details

I. General information

NPI: 1760517403
Provider Name (Legal Business Name): MS. MARIA DE LA LUZ MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E MORNINGSIDE ST
LONG BEACH CA
90805-6415
US

IV. Provider business mailing address

425 E MORNINGSIDE ST
LONG BEACH CA
90805-6415
US

V. Phone/Fax

Practice location:
  • Phone: 310-279-0865
  • Fax:
Mailing address:
  • Phone: 310-279-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: