Healthcare Provider Details

I. General information

NPI: 1245828375
Provider Name (Legal Business Name): CAMERON MENDOZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

IV. Provider business mailing address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-5150
  • Fax:
Mailing address:
  • Phone: 479-986-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4522
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: