Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1134375926 |
---|---|
Provider Name | Martin M Mendoza |
First Address | Pasadena, CA 91105-2625 |
Second Address | Pasadena, CA 91105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 10/10/2019 |