Provider Demographics
NPI:1871047662
Name:MENDEZ, ARIADNA M
Entity type:Individual
Prefix:
First Name:ARIADNA
Middle Name:M
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 ONEIDA CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6423
Mailing Address - Country:US
Mailing Address - Phone:760-774-6021
Mailing Address - Fax:
Practice Address - Street 1:5445 ONEIDA CT
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6423
Practice Address - Country:US
Practice Address - Phone:760-774-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86069068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered