Provider Demographics
NPI:1689688343
Name:ANTHONY L. MENDOZA, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY L. MENDOZA, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-632-1258
Mailing Address - Street 1:823 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-281-0125
Mailing Address - Fax:626-281-0102
Practice Address - Street 1:8207 ELDEN AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1012
Practice Address - Country:US
Practice Address - Phone:562-632-1258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19922OtherMEDICARE GROUP ID
CAWA73075BMedicare PIN
CAW19922OtherMEDICARE GROUP ID