Provider Demographics
NPI:1447756705
Name:MENDOZA, ERNESTO REINNIERI (LMT)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:REINNIERI
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2704
Mailing Address - Country:US
Mailing Address - Phone:360-574-5944
Mailing Address - Fax:360-574-6430
Practice Address - Street 1:13800 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2704
Practice Address - Country:US
Practice Address - Phone:360-574-5944
Practice Address - Fax:360-574-6430
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60838650225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist