Provider Demographics
NPI:1558488692
Name:MENDEZ, JOSE
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3314
Mailing Address - Country:US
Mailing Address - Phone:310-833-3135
Mailing Address - Fax:310-833-3572
Practice Address - Street 1:160 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3314
Practice Address - Country:US
Practice Address - Phone:310-833-3135
Practice Address - Fax:310-833-3572
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator