Provider Demographics
NPI:1356319032
Name:MENDES, FREDRIC STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:STEVEN
Last Name:MENDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 NINTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1937
Mailing Address - Country:US
Mailing Address - Phone:415-759-1979
Mailing Address - Fax:
Practice Address - Street 1:2322 NINTH AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1937
Practice Address - Country:US
Practice Address - Phone:415-759-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24300207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243000Medicaid
A86768Medicare UPIN
CA00A243000Medicare ID - Type Unspecified