Provider Demographics
NPI:1063861946
Name:MENDEZ CANTU, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MENDEZ CANTU
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 1:3305 MAIN ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2255
Mailing Address - Country:US
Mailing Address - Phone:360-693-8064
Mailing Address - Fax:360-693-7206
Practice Address - Street 1:3305 MAIN ST
Practice Address - Street 2:SUITE 117
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2255
Practice Address - Country:US
Practice Address - Phone:360-693-8064
Practice Address - Fax:360-693-7206
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60654074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist