Healthcare Provider Details

I. General information

NPI: 1417755372
Provider Name (Legal Business Name): VALERIA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SEVERIN DR
LA MESA CA
91942-3806
US

IV. Provider business mailing address

2340 MALLARD CT
LEMON GROVE CA
91945-3472
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-2606
  • Fax:
Mailing address:
  • Phone: 310-658-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number528759
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: