Provider Demographics
NPI:1124426127
Name:MENDOZA, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ASINAS
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:330 S GARFIELD AVE
Mailing Address - Street 2:STE 268
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3892
Mailing Address - Country:US
Mailing Address - Phone:626-281-3265
Mailing Address - Fax:626-300-0056
Practice Address - Street 1:330 S GARFIELD AVE
Practice Address - Street 2:STE 268
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3892
Practice Address - Country:US
Practice Address - Phone:626-281-3265
Practice Address - Fax:626-300-0056
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF0814018363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care