Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 95018479 | CA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95018479 | CA |
NPI | 1356011308 |
---|---|
Provider Name | Brett Allan Mendez |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2021 |
Last Update Date | 11/02/2022 |