Healthcare Provider Details

I. General information

NPI: 1063345817
Provider Name (Legal Business Name): WILSON DARWIN MENDEZ MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

PO BOX 470611
LOS ANGELES CA
90047-9311
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-2998
  • Fax:
Mailing address:
  • Phone: 213-713-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: