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General NPI Number Information
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NPI Number | 1942112933
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Entity Type | Individual
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Provider Name | ARIELLE MENDIETA-LILES
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 295 E C ST
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City | DIXON
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State | CA
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Zip | 95620-3019
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Country | US
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Telephone | 707-646-7681
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Fax |
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Provider Business Mailing Address
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Address Line | 1376 RENEWAL LN
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City | FAIRFIELD
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State | CA
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Zip | 94533-7145
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 34503
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License Number State | CA
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