Individual
RICHARD MARK MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
39400 PASEO PADRE PKWY, FREMONT, CA 94538-2310
(510) 784-4305
Mailing address
ABC, ABC, NV 12345-1030
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
989
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN3085710
MEDICAL
CA
Enumeration date
12/13/2006
Last updated
07/09/2007
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