Provider Demographics
NPI:1821547548
Name:MENDOZA, DANIELE DAWN (DC, CMT)
Entity Type:Individual
Prefix:DR
First Name:DANIELE
Middle Name:DAWN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5532
Mailing Address - Country:US
Mailing Address - Phone:408-348-3467
Mailing Address - Fax:
Practice Address - Street 1:60 DESCANSO DR UNIT 2209
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1819
Practice Address - Country:US
Practice Address - Phone:408-348-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5877101440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor