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General NPI Number Information
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NPI Number | 1376173666
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Entity Type | Individual
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Provider Name | ANAHI LIZBETH GAMINO MENDOZA FNP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2020
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 7755 LA MESA WAY
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City | BUENA PARK
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State | CA
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Zip | 90620-2327
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Country | US
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Telephone | 562-209-0160
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Fax |
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Provider Business Mailing Address
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Address Line | 7755 LA MESA WAY
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City | BUENA PARK
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State | CA
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Zip | 90620-2327
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Country | US
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Telephone |
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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 | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | 95075611
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95019401
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License Number State | CA
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