Healthcare Provider Details

I. General information

NPI: 1801708011
Provider Name (Legal Business Name): LOURDES MARISOL MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13408 VAN NUYS BLVD
PACOIMA CA
91331-3007
US

IV. Provider business mailing address

13408 VAN NUYS BLVD
PACOIMA CA
91331-3007
US

V. Phone/Fax

Practice location:
  • Phone: 818-492-8014
  • Fax:
Mailing address:
  • Phone: 818-492-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number02334457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: