Provider Demographics
NPI:1023023405
Name:MENDIOLA, PAUL P (OT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:P
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6956
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-6956
Mailing Address - Country:US
Mailing Address - Phone:928-343-7911
Mailing Address - Fax:928-343-9528
Practice Address - Street 1:1951 W 25TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6925
Practice Address - Country:US
Practice Address - Phone:928-726-7900
Practice Address - Fax:928-726-7901
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ803909Medicaid
AZ803909Medicaid