Provider Demographics
NPI:1639139959
Name:MULLENS, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MULLENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WELCH RD
Mailing Address - Street 2:STE C6
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-324-2091
Mailing Address - Fax:650-324-4404
Practice Address - Street 1:1101 WELCH RD
Practice Address - Street 2:STE C6
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-324-2091
Practice Address - Fax:650-324-4404
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1418213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOOE14180Medicare ID - Type Unspecified
T10947Medicare UPIN
0307430001Medicare NSC