Provider Demographics
NPI:1669138111
Name:MENDOZA, RHEAN-HEATHER M
Entity type:Individual
Prefix:
First Name:RHEAN-HEATHER
Middle Name:M
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 LEAFTREE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3055
Mailing Address - Country:US
Mailing Address - Phone:408-464-6936
Mailing Address - Fax:408-884-2314
Practice Address - Street 1:2005 DE LA CRUZ BLVD STE 235
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-3026
Practice Address - Country:US
Practice Address - Phone:408-905-3351
Practice Address - Fax:408-884-2314
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty