Provider Demographics
NPI:1568278356
Name:MENDEZ MORA, BRENDA ELIZABETH
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:MENDEZ MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ELIZABETH
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:669 W 34TH ST STE 102L
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0411
Mailing Address - Country:US
Mailing Address - Phone:213-821-5977
Mailing Address - Fax:
Practice Address - Street 1:669 W 34TH ST STE 102L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0411
Practice Address - Country:US
Practice Address - Phone:213-821-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program