Healthcare Provider Details

I. General information

NPI: 1700735669
Provider Name (Legal Business Name): MARISSA KEREN MENDOZA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 EL CAJON BLVD STE 200
LA MESA CA
91942-6712
US

IV. Provider business mailing address

1575 TANGLEWOOD LN APT N254
ESCONDIDO CA
92029-3225
US

V. Phone/Fax

Practice location:
  • Phone: 619-647-6157
  • Fax: 858-997-2088
Mailing address:
  • Phone: 505-819-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: