Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033611496 |
---|---|
Provider Name | Stephanie Mendoza |
First Address | Compton, CA 90221-2605 |
Second Address | Compton, CA 90221-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 01/03/2018 |