1053404392 NPI number — DONNA JEAN MENDELSON-GUTIERREZ MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053404392 NPI number — DONNA JEAN MENDELSON-GUTIERREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDELSON-GUTIERREZ
Provider First Name:
DONNA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053404392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W CARSON ST # 488
Provider Second Line Business Mailing Address:
HARBOR - UCLA HOSPITAL
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90502-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-222-3180
Provider Business Mailing Address Fax Number:
310-320-3521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W CARSON ST # 488
Provider Second Line Business Practice Location Address:
HARBOR - UCLA HOSPITAL
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90502-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-222-3180
Provider Business Practice Location Address Fax Number:
310-320-3521
Provider Enumeration Date:
10/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  G068388 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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