Basic Information
| Provider Information | |||||||||
| NPI: | 1104871276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | MARCEL | ||||||||
| MiddleName: | ALIMBUYUGUEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MFC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5628 E SLAUSON AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900402922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234809242 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Practice Location | |||||||||
| Address1: | 5628 E SLAUSON AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234809242 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC39920 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | MFC39920 | 01 | CA | MFC | OTHER |