Provider Demographics
NPI:1053590380
Name:MENDOZA, RAMON MARCIAL (DC)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:MARCIAL
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1340
Mailing Address - Country:US
Mailing Address - Phone:323-261-6131
Mailing Address - Fax:323-261-6231
Practice Address - Street 1:2172 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1340
Practice Address - Country:US
Practice Address - Phone:323-261-6131
Practice Address - Fax:323-261-6231
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA500314Medicare PIN
CAT04678Medicare UPIN