Healthcare Provider Details

I. General information

NPI: 1356319032
Provider Name (Legal Business Name): FREDRIC STEVEN MENDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 NINTH AVENUE
SAN FRANCISCO CA
94116-1937
US

IV. Provider business mailing address

2322 NINTH AVENUE
SAN FRANCISCO CA
94116-1937
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-1979
  • Fax:
Mailing address:
  • Phone: 415-759-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA24300
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA24300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: