Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1588964464 |
---|---|
Provider Name | Mr. Juan Antonio Mendoza |
First Address | San Diego, CA 92120-3428 |
Second Address | San Diego, CA 92120-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 26/10/2010 |