Provider Demographics
NPI:1437555067
Name:ESGUERRA MENDOZA, MARIA AURORA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AURORA
Last Name:ESGUERRA MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10823 STILL HOLLOW RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8857
Mailing Address - Country:US
Mailing Address - Phone:260-385-1740
Mailing Address - Fax:
Practice Address - Street 1:10823 STILL HOLLOW RUN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8857
Practice Address - Country:US
Practice Address - Phone:260-385-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist