MEDICARE: MARCEL ALIMBUYUGUEN MENDOZA MFC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC39920	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC39920	OTHER	CA	MFC

General Provider Information

NPI Number	:	1104871276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCEL ALIMBUYUGUEN MENDOZA MFC

Provider Business Mailing Address
First Line	:	5628 E SLAUSON AVE
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-2922
Country	:	US
Telephone Number	:	323-480-9242
Fax Number	:	323-780-3211

Provider Business Practice Location Address
First Line	:	5628 E SLAUSON AVE
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040
Country	:	US
Telephone Number	:	323-480-9242
Fax Number	:	323-780-3211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/31/2018

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