Healthcare Provider Details

I. General information

NPI: 1447230578
Provider Name (Legal Business Name): MARIA ELOISA MENDOZA AVEO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ATRIUM PARKWAY
NAPA CA
94559
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 707-257-4957
  • Fax:
Mailing address:
  • Phone: 971-206-5200
  • Fax: 917-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: