Provider Demographics
NPI:1649645003
Name:MENDOZA, JENA (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 WINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9809
Mailing Address - Country:US
Mailing Address - Phone:209-398-8740
Mailing Address - Fax:209-222-6185
Practice Address - Street 1:468 WINTON PKWY
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-9809
Practice Address - Country:US
Practice Address - Phone:209-398-8740
Practice Address - Fax:209-222-6185
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT43502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist