Provider Demographics
NPI:1871032730
Name:MENDOZA, TIANE (DPT)
Entity Type:Individual
Prefix:
First Name:TIANE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6586 AMHERST WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5422
Mailing Address - Country:US
Mailing Address - Phone:424-202-4481
Mailing Address - Fax:
Practice Address - Street 1:22 CORPORATE PLAZA, SUITE 113
Practice Address - Street 2:NEWPORT ORTHOPEDIC INSTITUTE
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-722-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist