Healthcare Provider Details

I. General information

NPI: 1811245541
Provider Name (Legal Business Name): RYAN ROBERT MENDIOLA CLAROS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30141 ANTELOPE RD STE. A
MENIFEE CA
92584-7001
US

IV. Provider business mailing address

24630 WASHINGTON AVE STE. 200
MURRIETA CA
92562-6131
US

V. Phone/Fax

Practice location:
  • Phone: 951-723-1866
  • Fax: 951-723-1867
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 39454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: