Provider Demographics
NPI:1710301726
Name:MENDES, CIARA (BA)
Entity Type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:
Last Name:MENDES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOLTON PL
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5316
Mailing Address - Country:US
Mailing Address - Phone:508-427-4393
Mailing Address - Fax:508-427-4394
Practice Address - Street 1:15 BOLTON PL
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5316
Practice Address - Country:US
Practice Address - Phone:508-427-4393
Practice Address - Fax:508-427-4394
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program