Provider Demographics
NPI:1811123417
Name:MENDOZA, JOHN (DPO II)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DPO II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 CIVIC CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1679
Mailing Address - Country:US
Mailing Address - Phone:323-780-2185
Mailing Address - Fax:
Practice Address - Street 1:9150 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2835
Practice Address - Country:US
Practice Address - Phone:562-940-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator