Healthcare Provider Details

I. General information

NPI: 1902493760
Provider Name (Legal Business Name): ALEXANDRIA ROSE MENDEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

885 SHASTA CIR
EL DORADO HILLS CA
95762-4557
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone: 530-391-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number21895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: