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NPI Code Detail

MEDICARE: MR. JONATHAN RAY GAERLAN MENDOZA PTA

MEDICARE: MR. JONATHAN RAY GAERLAN MENDOZA PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant8637CA

General Provider Information

NPI Number : 1285891564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONATHAN RAY GAERLAN MENDOZA PTA
Provider Business Mailing Address
First Line : 57 VIOLA ST
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-7321
Country : US
Telephone Number : 650-430-3054
Fax Number :
Provider Business Practice Location Address
First Line : 2707 PINE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2522
Country : US
Telephone Number : 415-563-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 05/22/2008

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