Healthcare Provider Details

I. General information

NPI: 1003150343
Provider Name (Legal Business Name): BRENDA G MENDOZA P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PARK ST
PASO ROBLES CA
93446-2160
US

IV. Provider business mailing address

1711 CURRENT LN
PASO ROBLES CA
93446-1900
US

V. Phone/Fax

Practice location:
  • Phone: 805-237-0272
  • Fax:
Mailing address:
  • Phone: 619-852-2654
  • Fax: 805-286-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT5896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: