Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 16207 | SC |
NPI | 1205037702 |
---|---|
Provider Name | Tarina Marlene Mendes |
First Address | Seneca, SC 29672-2468 |
Second Address | Seneca, SC 29678-3245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162077 | (05) | SC |