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General NPI Number Information
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NPI Number | 1417599002
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Entity Type | Individual
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Provider Name | TOMAS FEDERICO MENDOZA L.AC.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 1407 GARDEN ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3917
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Country | US
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Telephone | 805-242-1060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406-1004
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Country | US
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Telephone | 760-201-7768
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 10731
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License Number State | CA
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