Provider Demographics
NPI:1316513401
Name:MENDOZA, ADRIANA MARYANNA (ATC)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MARYANNA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:DANA
Mailing Address - State:NC
Mailing Address - Zip Code:28724-1125
Mailing Address - Country:US
Mailing Address - Phone:828-702-5575
Mailing Address - Fax:
Practice Address - Street 1:6 CLEM RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-5689
Practice Address - Country:US
Practice Address - Phone:828-702-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer