Healthcare Provider Details

I. General information

NPI: 1194748681
Provider Name (Legal Business Name): MICHELLE MENDOZA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SACRAMENTO ST STE 111
SAN FRANCISCO CA
94115-2383
US

IV. Provider business mailing address

PO BOX 254947
SACRAMENTO CA
95865-4947
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3604
  • Fax:
Mailing address:
  • Phone: 916-854-6975
  • Fax: 916-854-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: