MEDICARE: JESS MENDOZA

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
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1295937241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS MENDOZA

Provider Business Mailing Address
First Line	:	5807 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-5303
Country	:	US
Telephone Number	:	323-234-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	5849 CROCKER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1311
Country	:	US
Telephone Number	:	323-234-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	12/04/2013

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Directions to “ JESS MENDOZA ” Practice Location

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