Provider Demographics
NPI:1942818828
Name:MENDOZA, ERIKA (MT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7546 W FOREST GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1656
Mailing Address - Country:US
Mailing Address - Phone:602-405-1387
Mailing Address - Fax:
Practice Address - Street 1:7546 W FOREST GROVE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1656
Practice Address - Country:US
Practice Address - Phone:602-405-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT--06639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist