Provider Demographics
NPI:1902166879
Name:MENDEZ, LOUIS (CST)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12265 VENTURA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2528
Mailing Address - Country:US
Mailing Address - Phone:310-691-5411
Mailing Address - Fax:
Practice Address - Street 1:12265 VENTURA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2528
Practice Address - Country:US
Practice Address - Phone:310-691-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114160246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114160OtherTHE NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING