Provider Demographics
NPI:1508176603
Name:MENDOZA, VIRGINIA GUTERAC (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:GUTERAC
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3121
Mailing Address - Country:US
Mailing Address - Phone:310-833-4598
Mailing Address - Fax:310-833-3886
Practice Address - Street 1:601 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3121
Practice Address - Country:US
Practice Address - Phone:310-833-4598
Practice Address - Fax:310-833-3886
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor