Individual
ILIAN OMAR MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9333 IMPERIAL HWY, DOWNEY, CA 90242-2812
(800) 823-4040
Mailing address
1079 GAVIOTA AVE, LONG BEACH, CA 90813-3811
(562) 708-3651
Taxonomy
Speciality
Code
Description
License number
State
2278P3900X
Neonatal/Pediatric Certified Respiratory Therapist
Primary
25067
CA
Other
Enumeration date
10/24/2018
Last updated
10/24/2018
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