Pedro J Mendez, ACSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

63968 Issued in CA

Practice address

4390 Tweedy Blvd
South Gate, CA 90280-6237

Phone

(323) 567-0596

NPI assigned

May 17, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Silver Lake Psychology Inc.

  • Psychologist
  • Los Angeles, CA
  • NPI 1932651817
  Medicare reassignment

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1669818613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4390 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806237",
            "telephone_number": "310-603-6949",
            "fax_number": "323-583-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4390 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806237",
            "telephone_number": "323-567-0596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "PEDRO",
        "middle_name": "J",
        "credential": "ACSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-17",
        "last_updated": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "63968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Alexander Mejia Serrano
• Nuria Michelle Melgar
• Jack Paul Melmed, OPTOMETRIST
• Sophone R Men
• Ivan Mendez
• Francisco Mendoza
• Emily Mercado, B.A
• Mi Young Han
• Mia Larissa Ancheta, DDS, a Dental Corporation
• Millot DDS Inc

• Mental Health Counselor in South Gate, CA
• Providers in South Gate, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.