Active NPI
Sam Nicole Encarnacion Mendoza I, CMT, B.S.KIN
- Massage Therapist
- San Diego, CA
National Provider Identifier
1790660868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 95954
- Practice address
- 5959 Mission Gorge Rd Ste 106
San Diego, CA 92120-4019 - Phone
- (619) 754-4809
- NPI assigned
- Aug 7, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 95954 | CA | Primary |
Addresses
Primary practice location
5959 Mission Gorge Rd Ste 106
San Diego, CA 92120-4019
Mailing address
665 Carefree Dr
San Diego, CA 92114-5753
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95954 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754524800000",
"number": "1790660868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 CAREFREE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921145753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5959 MISSION GORGE RD STE 106",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921204019",
"telephone_number": "619-754-4809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "SAM NICOLE",
"middle_name": "ENCARNACION",
"name_suffix": "I",
"credential": "CMT, B.S.KIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-07",
"last_updated": "2025-08-07",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "95954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.