Individual
FANNIELYN MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 CHEYENNE TRL, MANSFIELD, TX 76063-7955
(415) 870-5990
Mailing address
1510 CHEYENNE TRL, MANSFIELD, TX 76063-7955
(415) 870-5990
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212074
TX
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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