Individual
CARLENE ANN MENDIETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
155 5TH ST, SAN FRANCISCO, CA 94103-2919
(415) 929-6501
Mailing address
19500 7TH ST E, SONOMA, CA 95476-7201
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
34741
CA
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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