Individual
RICHARD J. MENDIETA
Active
Individual
RICHARD J. MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
19317
WV
208000000X
Pediatrics Physician
Primary
35-07-2682
OH
208000000X
Pediatrics Physician
35.072682
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007410
ANTHEM BCBS
—
01
—
000000181967
UNISON MEDICAID
OH
01
—
001714096
MOUNTAIN STATE BCBS
—
05
—
0111033000
—
WV
01
—
2037718
MOLINA MEDICAID
OH
01
—
310917085028
CARESOURCE MEDICAID
OH
01
—
370008914
RR MEDICARE
—
Enumeration date
05/30/2006
Last updated
11/04/2020
Update your record
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