Provider Demographics
NPI:1255984191
Name:MENDOZA, CARLOS F (SLD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:F
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:SLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22323 SHERMAN WAY STE 14
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4310
Mailing Address - Country:US
Mailing Address - Phone:818-886-5447
Mailing Address - Fax:818-232-7041
Practice Address - Street 1:22323 SHERMAN WAY STE 14
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4310
Practice Address - Country:US
Practice Address - Phone:818-886-5447
Practice Address - Fax:818-232-7041
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41037156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician