Active NPI
Rudy Steven Mendoza, DDS
- Dentist
- Long Beach, CA
National Provider Identifier
1467558338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29171
- Practice address
- 392 Redondo Ave
Long Beach, CA 90814 - Phone
- (562) 438-0592
- Fax
- (562) 433-6442
- NPI assigned
- Sep 16, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 29171 | CA | Primary |
Addresses
Primary practice location
392 Redondo Ave
Long Beach, CA 90814
Mailing address
392 Redondo Ave
Long Beach, CA 90814
Phone (562) 438-0592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 9, 2016 through May 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29171 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467558338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "392 REDONDO AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90814",
"telephone_number": "562-438-0592",
"fax_number": "562-433-6442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "392 REDONDO AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90814",
"telephone_number": "562-438-0592",
"fax_number": "562-433-6442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "RUDY",
"middle_name": "STEVEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "29171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.