Provider Demographics
NPI:1184897746
Name:MOJARES, REYNALDO MENDOZA (PT)
Entity type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:MENDOZA
Last Name:MOJARES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:28975 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2863
Mailing Address - Country:US
Mailing Address - Phone:951-595-1738
Mailing Address - Fax:951-595-1738
Practice Address - Street 1:28975 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2863
Practice Address - Country:US
Practice Address - Phone:951-595-1738
Practice Address - Fax:951-595-1738
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ666ZMedicare PIN