Provider Demographics
NPI:1588712541
Name:MENDOZA, JOSE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 DOWNEY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1405
Mailing Address - Country:US
Mailing Address - Phone:562-531-4362
Mailing Address - Fax:562-531-2169
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1405
Practice Address - Country:US
Practice Address - Phone:562-531-4362
Practice Address - Fax:562-531-2169
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA321172080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A84313Medicare UPIN