Healthcare Provider Details

I. General information

NPI: 1801097662
Provider Name (Legal Business Name): ALBERTO MENDIVIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD. SUITE 507
NEWPORT BEACH CA
92663
US

IV. Provider business mailing address

351 HOSPITAL RD. SUITE 507
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-1361
  • Fax: 949-642-1608
Mailing address:
  • Phone: 949-642-1361
  • Fax: 949-642-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA90983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: