Provider Demographics
NPI:1235728445
Name:MENDOZA, MELISSA LORRAINE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LORRAINE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N SUNSET AVE APT 41
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-1262
Mailing Address - Country:US
Mailing Address - Phone:626-975-8155
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 117
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2772
Practice Address - Country:US
Practice Address - Phone:562-426-9890
Practice Address - Fax:562-426-7809
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16-1138246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant