Provider Demographics
NPI:1932477460
Name:PELLANDINI, DAVID L (HAD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PELLANDINI
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5401
Mailing Address - Country:US
Mailing Address - Phone:707-962-9230
Mailing Address - Fax:707-962-9230
Practice Address - Street 1:103 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5401
Practice Address - Country:US
Practice Address - Phone:707-962-9230
Practice Address - Fax:707-523-0260
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2892237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA2892OtherHA DISPENSER LICENSE