Healthcare Provider Details

I. General information

NPI: 1942112933
Provider Name (Legal Business Name): ARIELLE MENDIETA-LILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIELLE MENDIETA

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 E C ST
DIXON CA
95620-3019
US

IV. Provider business mailing address

1376 RENEWAL LN
FAIRFIELD CA
94533-7145
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-7681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number34503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: