Provider Demographics
NPI:1871536797
Name:MENDOZA, ASTRID (DO)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 780
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-543-2532
Mailing Address - Fax:310-540-9707
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 780
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-543-2532
Practice Address - Fax:310-540-9707
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6959207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX69590Medicaid
CAH22586Medicare UPIN
CA20A6959Medicare ID - Type UnspecifiedMEDICARE PROVIDER #