Healthcare Provider Details

I. General information

NPI: 1710121520
Provider Name (Legal Business Name): ENRIQUE MENDOZA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL SUITE 102
OCEANSIDE CA
92054-6306
US

IV. Provider business mailing address

3905 WARING RD
OCEANSIDE CA
92056-4405
US

V. Phone/Fax

Practice location:
  • Phone: 760-477-3150
  • Fax: 760-754-6785
Mailing address:
  • Phone: 760-724-9000
  • Fax: 760-724-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number35503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: