Healthcare Provider Details

I. General information

NPI: 1568057958
Provider Name (Legal Business Name): MEXUSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 KATELLA AVE STE 101
LOS ALAMITOS CA
90720-3448
US

IV. Provider business mailing address

4012 KATELLA AVE STE 101
LOS ALAMITOS CA
90720-3448
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-1131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AZAEL MONTOYA
Title or Position: CEO/MANAGING MEMBER
Credential:
Phone: 714-360-9297