Active NPI
Tracy Kim Mendoza
- Licensed Psychiatric Technician
- Los Angeles, CA
National Provider Identifier
1255877437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT34003
- Practice address
- 12021 Wilmington Ave
Los Angeles, CA 90059-3019 - Phone
- (310) 221-6336
- NPI assigned
- Jan 12, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT34003 | CA | Primary |
Addresses
Primary practice location
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Mailing address
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone (310) 221-6336
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT34003 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1255877437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593019",
"telephone_number": "310-221-6336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593019",
"telephone_number": "310-221-6336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "TRACY",
"middle_name": "KIM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-12",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT34003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.