Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT5896 | CA |
NPI | 1003150343 |
---|---|
Provider Name | Mrs. Brenda G Mendoza |
First Address | Paso Robles, CA 93446-1900 |
Second Address | Paso Robles, CA 93446-2160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |