Provider Demographics
NPI:1154201606
Name:MENDOZA, TANYA (LMT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-741 KUPUOHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1126
Mailing Address - Country:US
Mailing Address - Phone:808-398-8919
Mailing Address - Fax:
Practice Address - Street 1:94-741 KUPUOHI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1126
Practice Address - Country:US
Practice Address - Phone:808-398-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist