Healthcare Provider Details

I. General information

NPI: 1306236757
Provider Name (Legal Business Name): IRLANDA MENDEZ PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

IV. Provider business mailing address

510 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-3600
  • Fax: 213-483-4555
Mailing address:
  • Phone: 213-483-3600
  • Fax: 213-483-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: