Healthcare Provider Details

I. General information

NPI: 1255247649
Provider Name (Legal Business Name): MALIA MENDIOLA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 KENYON ST STE 201
SAN DIEGO CA
92110-5341
US

IV. Provider business mailing address

1425 PHILLIPS CIR
VISTA CA
92083-7676
US

V. Phone/Fax

Practice location:
  • Phone: 619-436-1187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: