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NPI Code Detail

MEDICARE: TIANE MARIE MENDOZA DPT

MEDICARE: TIANE MARIE MENDOZA DPT
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
1225100000XPhysical Therapist292773CA

General Provider Information

NPI Number : 1871032730
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIANE MARIE MENDOZA DPT
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10250 SANTA MONICA BLVD STE 2440
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-6593
Country : US
Telephone Number : 310-286-0122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2017
Last Update Date : 02/02/2026

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Directions to “ TIANE MARIE MENDOZA DPT” Practice Location

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