1336516103 NPI number — ALAN JOSEPH MENDES PT, DPT

Table of content: ALAN JOSEPH MENDES PT, DPT (NPI 1336516103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336516103 NPI number — ALAN JOSEPH MENDES PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDES
Provider First Name:
ALAN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336516103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1489 W LACEY BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230-5957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-585-8087
Provider Business Mailing Address Fax Number:
559-585-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S MADERA AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93630-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-846-6336
Provider Business Practice Location Address Fax Number:
559-846-3344
Provider Enumeration Date:
08/28/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  42935 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)