MEDICARE: MR. ENRIQUE MENDOZA DPT

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	2251X0800X	Orthopedic Physical Therapist	35503	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CI933Z	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35503	OTHER	CA	CALIFORNIA LICENSE NUMBER

General Provider Information

NPI Number	:	1710121520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ENRIQUE MENDOZA DPT

Provider Business Mailing Address
First Line	:	3905 WARING RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4405
Country	:	US
Telephone Number	:	760-724-9000
Fax Number	:	760-724-3686

Provider Business Practice Location Address
First Line	:	2204 S EL CAMINO REAL
Second Line	:	SUITE 102
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6306
Country	:	US
Telephone Number	:	760-477-3150
Fax Number	:	760-754-6785

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	12/03/2009

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Directions to “ MR. ENRIQUE MENDOZA DPT” Practice Location

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