Provider Demographics
NPI:1922286509
Name:MENDOZA, CLARISSA M (RN/PHN)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:M
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RN/PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 AERO JET AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2803
Mailing Address - Country:US
Mailing Address - Phone:626-569-6151
Mailing Address - Fax:626-569-1905
Practice Address - Street 1:3400 AERO JET AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2803
Practice Address - Country:US
Practice Address - Phone:626-569-6151
Practice Address - Fax:626-569-1905
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416841163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management