Provider Demographics
NPI:1699382762
Name:MENDOZA, TRAVIS EDUARDO I (LMT)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:EDUARDO
Last Name:MENDOZA
Suffix:I
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 1:27766 DEL NORTE CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4117
Mailing Address - Country:US
Mailing Address - Phone:650-307-4118
Mailing Address - Fax:
Practice Address - Street 1:27766 DEL NORTE CT
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4117
Practice Address - Country:US
Practice Address - Phone:650-307-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38731225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist