Healthcare Provider Details

I. General information

NPI: 1699605238
Provider Name (Legal Business Name): MS. ROSANNA MENDEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S AVENUE 57 APT 4
LOS ANGELES CA
90042-5203
US

IV. Provider business mailing address

327 S AVENUE 57 APT 4
LOS ANGELES CA
90042-5203
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-4826
  • Fax:
Mailing address:
  • Phone: 818-445-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number011563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: