Healthcare Provider Details

I. General information

NPI: 1114005196
Provider Name (Legal Business Name): GINA MARIE MENDIOLA RD, CSR, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

745 ECTON RD
AKRON OH
44303-1651
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-6130
  • Fax: 330-375-3421
Mailing address:
  • Phone: 330-869-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD3064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: