Provider Demographics
NPI:1487969960
Name:MENDES, CRYSTAL LAILLA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LAILLA
Last Name:MENDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BARTON RD APT 2307
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5349
Mailing Address - Country:US
Mailing Address - Phone:909-936-1451
Mailing Address - Fax:
Practice Address - Street 1:1601 BARTON RD APT 2307
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5349
Practice Address - Country:US
Practice Address - Phone:909-936-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered