Healthcare Provider Details

I. General information

NPI: 1528265881
Provider Name (Legal Business Name): MARLYN MENDOZA ALEJANDRO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

11824 EDGECLIFF AVE
SYLMAR CA
91342-5477
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8051
  • Fax:
Mailing address:
  • Phone: 818-367-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number20118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: