Provider Demographics
NPI:1194571398
Name:ALEJANDRA D. MENDIZABAL REGISTERED NURSING AND FAMILY PRACTICE INC
Entity type:Organization
Organization Name:ALEJANDRA D. MENDIZABAL REGISTERED NURSING AND FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:DAMAYANTI
Authorized Official - Last Name:MENDIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:661-666-7238
Mailing Address - Street 1:14325 TORI CT
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9653 ALDER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6129
Practice Address - Country:US
Practice Address - Phone:909-600-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty