Individual
JORGE CAMILO MENDEZ VIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18321 CLARK ST, TARZANA, CA 91356-3501
(818) 708-5172
Mailing address
18321 CLARK ST, TARZANA, CA 91356-3501
(818) 708-5172
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
E144860
CA
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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