Individual
YISEL MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 LOMAX ST, IDAHO FALLS, ID 83401
(208) 522-6925
(208) 522-6934
Mailing address
522 LOMAX ST, IDAHO FALLS, ID 83401
(208) 522-6925
(208) 522-6934
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
000
ID
Other
Enumeration date
12/07/2023
Last updated
12/07/2023
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