Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 70150 | MN |
NPI | 1255711123 |
---|---|
Provider Name | Bryan Mendes |
First Address | Roseville, MN 55113-1306 |
Second Address | Roseville, MN 55113-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 10/12/2021 |