Healthcare Provider Details

I. General information

NPI: 1801282645
Provider Name (Legal Business Name): CYNTHIA MENDEZ-KOHLIEBER M.D, M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 J ST
SACRAMENTO CA
95814
US

IV. Provider business mailing address

17437 MANTECA ST
VAN NUYS CA
91406-2452
US

V. Phone/Fax

Practice location:
  • Phone: 916-497-2900
  • Fax:
Mailing address:
  • Phone: 310-775-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number148780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: