Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 31601 | CA |
NPI | 1245660091 |
---|---|
Provider Name | Dr. Tirtha Mendake |
First Address | San Francisco, CA 94107-2708 |
Second Address | San Francisco, CA 94107-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 07/04/2016 |