Provider Demographics
NPI:1942977574
Name:PEREZ MENDOZA, LUIS FERNANDO (RADT II)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:FERNANDO
Last Name:PEREZ MENDOZA
Suffix:
Gender:M
Credentials:RADT II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 E COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3310
Mailing Address - Country:US
Mailing Address - Phone:310-608-1505
Mailing Address - Fax:
Practice Address - Street 1:1218 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3310
Practice Address - Country:US
Practice Address - Phone:323-399-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1436170621101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)