Provider Demographics
NPI:1972549194
Name:MENDOZA, RICARDO P (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:P
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21730 S VERMONT AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2196
Mailing Address - Country:US
Mailing Address - Phone:310-781-3426
Mailing Address - Fax:310-782-0854
Practice Address - Street 1:21730 S VERMONT AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2196
Practice Address - Country:US
Practice Address - Phone:310-781-3426
Practice Address - Fax:310-782-0854
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA381672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A381670Medicaid
CA00A381670Medicaid
CAWA38167FMedicare ID - Type UnspecifiedPPIN
CA00A381670Medicaid
CAWA38167EMedicare ID - Type UnspecifiedPPIN