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General NPI Number Information
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NPI Number | 1629984992
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Entity Type | Individual
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Provider Name | CARLOS MENDIETA
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Gender | Male
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 240 S MADISON ST
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City | IOWA CITY
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State | IA
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Zip | 52242
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Country | US
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Telephone | 909-731-0862
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Fax |
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Provider Business Mailing Address
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Address Line | 900 W BENTON ST APT 209C
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City | IOWA CITY
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State | IA
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Zip | 52246-5928
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Country | US
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Telephone | 909-731-0862
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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