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General NPI Number Information
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NPI Number | 1306274071
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Entity Type | Individual
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Provider Name | SUSY MENDOZA LMT
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Gender | Female
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 202 W PARK AVE SUITE 201
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City | LONG BEACH
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State | NY
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Zip | 11561-3212
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Country | US
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Telephone | 718-757-6384
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Fax |
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Provider Business Mailing Address
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Address Line | 30 DARTMOUTH ST
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3214
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Country | US
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Telephone | 718-757-6384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 024660-1
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License Number State | NY
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