MEDICARE: JAMES ALDRICH MENDOZA D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	42086	CA

General Provider Information

NPI Number	:	1417345539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ALDRICH MENDOZA D.P.T.

Provider Business Mailing Address
First Line	:	5050 E GARFORD ST APT 259
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-5819
Country	:	US
Telephone Number	:	949-751-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 N BELLFLOWER BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1125
Country	:	US
Telephone Number	:	562-384-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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