Provider Demographics
NPI:1053967406
Name:MENDELMAR, DAVID NORMAN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NORMAN
Last Name:MENDELMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4572
Mailing Address - Country:US
Mailing Address - Phone:707-254-2656
Mailing Address - Fax:
Practice Address - Street 1:105 E ST STE 2E
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4572
Practice Address - Country:US
Practice Address - Phone:707-254-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical