Provider Demographics
NPI:1215115217
Name:MENTIS, MARNI L (DO)
Entity type:Individual
Prefix:DR
First Name:MARNI
Middle Name:L
Last Name:MENTIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3303
Mailing Address - Country:US
Mailing Address - Phone:727-365-8564
Mailing Address - Fax:
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:SUITE 310
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-474-0205
Practice Address - Fax:727-474-9179
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8521208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery