Provider Demographics
NPI:1396207312
Name:MENDIOLA, RITCHE (COTA)
Entity Type:Individual
Prefix:
First Name:RITCHE
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23518 FRIGATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5725
Mailing Address - Country:US
Mailing Address - Phone:424-210-1644
Mailing Address - Fax:
Practice Address - Street 1:23518 FRIGATE AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5725
Practice Address - Country:US
Practice Address - Phone:424-210-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility