Provider Demographics
NPI:1134375926
Name:MENDOZA, MARTIN M
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:M
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2625
Mailing Address - Country:US
Mailing Address - Phone:626-389-9411
Mailing Address - Fax:626-389-9344
Practice Address - Street 1:909 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-389-9411
Practice Address - Fax:626-389-9344
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER