Provider Demographics
NPI:1760572689
Name:MEDNICK, DAVID LLOYD (DPM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LLOYD
Last Name:MEDNICK
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 1:14 N. ABEL STREET
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4833
Mailing Address - Country:US
Mailing Address - Phone:408-262-1188
Mailing Address - Fax:408-262-1379
Practice Address - Street 1:14 N. ABEL STREET
Practice Address - Street 2:
Practice Address - City:MALPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4833
Practice Address - Country:US
Practice Address - Phone:408-262-1188
Practice Address - Fax:408-262-1379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E33571213E00000X
CAE3357213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11650Medicare UPIN
CA000E33571Medicare PIN
CA0896250001Medicare NSC
CA0896250001Medicare NSC