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General NPI Number Information
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NPI Number | 1255463592
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Entity Type | Individual
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Provider Name | SUSANA MARIBEL MENDOZA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4700 W SUNSET BLVD 2ND FLOOR, NEPHROLOGY DEPARTMENT
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City | LOS ANGELES
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State | CA
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Zip | 90027-6082
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Country | US
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Telephone | 323-783-5987
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 MURIETTA AVE
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2628
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Country | US
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Telephone | 310-903-1364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A87787
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License Number State | CA
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