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General NPI Number Information
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NPI Number | 1316320823
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Entity Type | Individual
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Provider Name | CHARLES ROBERT MENDELSON LAC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 3452 40TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-3420
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Country | US
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Telephone | 206-437-8073
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 QUEEN ANNE AVE N STE 204
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City | SEATTLE
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State | WA
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Zip | 98109-2876
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Country | US
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Telephone | 206-679-2421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60556797
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License Number State | WA
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