Provider Demographics
NPI:1902848864
Name:MENDOZA, ANTHONY LLOYD (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LLOYD
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2358
Mailing Address - Country:US
Mailing Address - Phone:562-464-5350
Mailing Address - Fax:
Practice Address - Street 1:7643 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2358
Practice Address - Country:US
Practice Address - Phone:562-464-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19922OtherMEDICARE GROUP ID
CAI24282Medicare UPIN
CAWA73075BMedicare PIN