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General NPI Number Information
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NPI Number | 1609755354
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Entity Type | Individual
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Provider Name | JOHN PAUL LIWANAG MENDOZA OTD, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2715 LILAC ST
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City | LONGVIEW
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State | WA
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Zip | 98632-3526
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Country | US
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Telephone | 360-575-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 35899 ESPERIA WAY
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City | FALLBROOK
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State | CA
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Zip | 92028-6535
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Country | US
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Telephone | 559-707-0670
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 455860
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 22577
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT61664045
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License Number State | WA
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