Provider Demographics
NPI:1700232972
Name:MENDOZA, JOSE ROSALIO JR (LMP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ROSALIO
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7801
Mailing Address - Country:US
Mailing Address - Phone:509-222-1112
Mailing Address - Fax:509-222-1113
Practice Address - Street 1:7131 W DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7801
Practice Address - Country:US
Practice Address - Phone:509-222-1112
Practice Address - Fax:509-222-1113
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60238709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor