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NPI Code Detail

MEDICARE: MR. JUAN ANTONIO MENDOZA CPO

MEDICARE: MR. JUAN ANTONIO MENDOZA CPO
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
1222Z00000XOrthotist
2224P00000XProsthetist
3225000000XOrthotic Fitter

General Provider Information

NPI Number : 1588964464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUAN ANTONIO MENDOZA CPO
Provider Business Mailing Address
First Line : 6190 FAIRMOUNT AVE
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92120-3428
Country : US
Telephone Number : 619-285-5040
Fax Number : 619-285-5045
Provider Business Practice Location Address
First Line : 6190 FAIRMOUNT AVE
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92120-3428
Country : US
Telephone Number : 619-285-5040
Fax Number : 619-285-5045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2010
Last Update Date : 10/26/2010

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