Provider Demographics
NPI:1215021357
Name:MENDEL, DANA L (PH D)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:MENDEL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1808
Mailing Address - Country:US
Mailing Address - Phone:858-623-3252
Mailing Address - Fax:858-623-3253
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-623-3252
Practice Address - Fax:858-623-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 14172OtherLICENSE NUMBER
CACP 14172Medicare ID - Type Unspecified