Provider Demographics
NPI:1477260784
Name:MENDOZA RAMOS, LUIS MANUEL (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MANUEL
Last Name:MENDOZA RAMOS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2125
Mailing Address - Country:US
Mailing Address - Phone:626-485-3271
Mailing Address - Fax:
Practice Address - Street 1:1601 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7930
Practice Address - Country:US
Practice Address - Phone:626-445-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4566224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant