Individual provider Active NPI

Susana Maribel Mendoza, M.D.

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1255463592
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A87787 Issued in CA
Practice address
4700 W Sunset Blvd
2ND Floor, Nephrology Department
Los Angeles, CA 90027-6082
Phone
(323) 783-5987
NPI assigned
Mar 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A87787 CA Primary

Addresses

Primary practice location

4700 W Sunset Blvd
2ND Floor, Nephrology Department
Los Angeles, CA 90027-6082

Mailing address

8920 Murietta Ave
Panorama City, CA 91402-2628
Phone (310) 903-1364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071018000679 CA Practitioner - NephrologyPractitioner - Internal Medicine 5496841652 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A87787CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles Current Accepting new patients
County of Los Angeles CurrentSince Feb 1, 2016 Accepting new patients
Northeast Valley Health Corporation CurrentSince Aug 1, 2015 Accepting new patients
Northeast Valley Health Corporation Current Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Feb 1, 2016 Accepting new patients
Northeast Valley Health Corporation CurrentSince Aug 1, 2015 Accepting new patients

Locations

7107 Remmet Ave
Canoga Park, CA 91303
Phone (818) 340-3570

7843 Lankershim Blvd
North Hollywood, CA 91605
Phone (818) 765-8656

1172 N Maclay Ave
San Fernando, CA 91340
Phone (818) 898-1388

14445 Olive View Dr
#2C155
Sylmar, CA 91342
Phone (818) 364-3001

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255463592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8920 MURIETTA AVE",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914022628",
            "telephone_number": "310-903-1364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W SUNSET BLVD",
            "address_2": "2ND FLOOR, NEPHROLOGY DEPARTMENT",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276082",
            "telephone_number": "323-783-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "SUSANA",
        "middle_name": "MARIBEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A87787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.