Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G41197 | CA |
NPI | 1336251107 |
---|---|
Provider Name | Anthony Mendesh |
First Address | Santa Barbara, CA 93160-2106 |
Second Address | Santa Barbara, CA 93105-4355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G411970 | (05) | CA |
A48488 | (02) | CA |