Provider Demographics
NPI:1275275117
Name:MENDEZ, IRVING ISAAC
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:ISAAC
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12615 BROCK AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4249
Mailing Address - Country:US
Mailing Address - Phone:562-454-2004
Mailing Address - Fax:
Practice Address - Street 1:CORTICA , 21515 HAWTHORNE BLVD STE GL-100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-9050
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician