Provider Demographics
NPI:1851179345
Name:ACOYMO, KERWIN MENDOZA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KERWIN
Middle Name:MENDOZA
Last Name:ACOYMO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 LA CLEDE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2230
Mailing Address - Country:US
Mailing Address - Phone:323-454-7735
Mailing Address - Fax:
Practice Address - Street 1:3267 LA CLEDE AVE APT 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2230
Practice Address - Country:US
Practice Address - Phone:323-545-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF09230501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily