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General NPI Number Information
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NPI Number | 1427757244
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Entity Type | Individual
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Provider Name | ALEXIS CAMILLE MENDOZA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 1212 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3411
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Country | US
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Telephone | 310-342-2592
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Fax | 310-324-3947
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 66672
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License Number State | CA
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