Provider Demographics
NPI:1295534162
Name:MENDOZA ALARCON, KRISTELLE JEMIMAH
Entity type:Individual
Prefix:
First Name:KRISTELLE
Middle Name:JEMIMAH
Last Name:MENDOZA ALARCON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18427 STUDEBAKER RD APT 158
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:805-953-5965
Mailing Address - Fax:
Practice Address - Street 1:25-21 49TH ST, LONG ISLAND CITY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103
Practice Address - Country:US
Practice Address - Phone:347-829-3890
Practice Address - Fax:347-829-3888
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist