Active NPI
Jose R Mendoza
- Physician Assistant
- Inglewood, CA
National Provider Identifier
1053561688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 19531
- Practice address
- 313 1/2 E Buckthorn St
Inglewood, CA 90301-3417 - Phone
- (310) 722-2114
- NPI assigned
- Sep 18, 2008
- Last updated
- Jul 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 19531 | NU | Primary |
Addresses
Primary practice location
313 1/2 E Buckthorn St
Inglewood, CA 90301-3417
Mailing address
PO Box 635
Hawthorne, CA 90251-0635
Phone (310) 722-2114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247702400000",
"number": "1053561688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 635",
"city": "HAWTHORNE",
"state": "CA",
"postal_code": "902510635",
"telephone_number": "310-722-2114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 1/2 E BUCKTHORN ST",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903013417",
"telephone_number": "310-722-2114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "JOSE",
"middle_name": "R",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-18",
"last_updated": "2009-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": "PA 19531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.