Individual
ROSE MENDIOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 STANFORD DR, VALLEJO, CA 94589-1746
(707) 246-7971
Mailing address
130 STANFORD DR, VALLEJO, CA 94589-1746
(707) 246-7971
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
R36801214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C0600029
—
CA
Enumeration date
09/01/2015
Last updated
09/01/2015
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