Basic Information
| Provider Information | |||||||||
| NPI: | 1477698645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 MONTANA ST APT D | ||||||||
| Address2: | #D | ||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910164172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264533399 | ||||||||
| FaxNumber: | 6264533398 | ||||||||
| Practice Location | |||||||||
| Address1: | 10428 LOWER AZUSA RD | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917311208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264533399 | ||||||||
| FaxNumber: | 6264533398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.