Provider Demographics
NPI:1710254461
Name:MENDOZA, ZIAN JOHN ATAYDE (DPT)
Entity Type:Individual
Prefix:MR
First Name:ZIAN JOHN
Middle Name:ATAYDE
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:CHRISTIAN
Other - Middle Name:ATAYDE
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:#16573 VENTURA BLVD #5
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-445-6732
Mailing Address - Fax:
Practice Address - Street 1:16573 VENTURA BLVD #5
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-990-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist