Provider Demographics
NPI:1104657642
Name:MENDRIX MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:MENDRIX MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-237-1281
Mailing Address - Street 1:8601 LINCOLN BLVD # 180-567
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-977-1496
Practice Address - Street 1:18726 S WESTERN AVE STE 320
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3812
Practice Address - Country:US
Practice Address - Phone:310-773-8975
Practice Address - Fax:702-977-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty