Provider Demographics
NPI:1699730754
Name:MENDOZA, KATRINA (MSED, ATC/L)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 CHANDALAR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-9435
Mailing Address - Country:US
Mailing Address - Phone:850-575-8340
Mailing Address - Fax:
Practice Address - Street 1:3838 TROJAN TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3810
Practice Address - Country:US
Practice Address - Phone:850-921-2516
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 19762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer