Provider Demographics
NPI:1053404392
Name:MENDELSON-GUTIERREZ, DONNA JEAN (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:MENDELSON-GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST # 488
Mailing Address - Street 2:HARBOR - UCLA HOSPITAL
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-3180
Mailing Address - Fax:310-320-3521
Practice Address - Street 1:1000 W CARSON ST # 488
Practice Address - Street 2:HARBOR - UCLA HOSPITAL
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3180
Practice Address - Fax:310-320-3521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0683882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEI147ZMedicare PIN