Provider Demographics
NPI:1487388443
Name:MENDIZABAL, ALEJANDRA DAMAYANTI
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:DAMAYANTI
Last Name:MENDIZABAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:DAMAYANTI
Other - Last Name:MENDIZABAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DELGADILLO
Mailing Address - Street 1:10139 BEVIS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9128 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6405
Practice Address - Country:US
Practice Address - Phone:818-892-7795
Practice Address - Fax:818-892-7797
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty