Healthcare Provider Details

I. General information

NPI: 1316916398
Provider Name (Legal Business Name): MARIA LUISA MENDOZA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W WASHINGTON BLVD
LOS ANGELES CA
90015-3316
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 213-623-2225
  • Fax:
Mailing address:
  • Phone: 702-954-7672
  • Fax: 213-861-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number369910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: