Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003279787 |
---|---|
Provider Name | Marvin Mendiola |
First Address | Fullerton, CA 92836-0919 |
Second Address | Fullerton, CA 92831-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 05/04/2018 |