MEDICARE: ERIKA MENDOZA MT

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	225700000X	Massage Therapist	MT--06639	AZ

General Provider Information

NPI Number	:	1942818828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA MENDOZA MT

Provider Business Mailing Address
First Line	:	7546 W FOREST GROVE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1656
Country	:	US
Telephone Number	:	602-405-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	7546 W FOREST GROVE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1656
Country	:	US
Telephone Number	:	602-405-1387
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “ ERIKA MENDOZA MT” Practice Location

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