Provider Demographics
NPI:1538326541
Name:MENDOZA, LESLIE AMALIA (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:AMALIA
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 1:434 W 111TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1523
Mailing Address - Country:US
Mailing Address - Phone:310-946-6671
Mailing Address - Fax:
Practice Address - Street 1:2799 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2210
Practice Address - Country:US
Practice Address - Phone:562-506-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor