Provider Demographics
NPI:1477698645
Name:MENDEZ, JOSE LUIS SR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:MENDEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MONTANA ST APT D
Mailing Address - Street 2:#D
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4172
Mailing Address - Country:US
Mailing Address - Phone:626-453-3399
Mailing Address - Fax:626-453-3398
Practice Address - Street 1:10428 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1208
Practice Address - Country:US
Practice Address - Phone:626-453-3399
Practice Address - Fax:626-453-3398
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner