Provider Demographics
NPI:1407579790
Name:MENDOZA, GUADALUPE (CMT, CLT, MLD, BLD)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CMT, CLT, MLD, BLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 W CLARK ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-0836
Mailing Address - Country:US
Mailing Address - Phone:559-660-5913
Mailing Address - Fax:
Practice Address - Street 1:1930 HOWARD RD STE H
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5152
Practice Address - Country:US
Practice Address - Phone:559-660-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist