Provider Demographics
NPI:1396939245
Name:LLANTADA, RUMEL MENDOZA (DC)
Entity type:Individual
Prefix:DR
First Name:RUMEL
Middle Name:MENDOZA
Last Name:LLANTADA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6930
Mailing Address - Country:US
Mailing Address - Phone:858-384-6556
Mailing Address - Fax:858-225-8320
Practice Address - Street 1:5252 BALBOA AVE STE 701
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6930
Practice Address - Country:US
Practice Address - Phone:858-384-6556
Practice Address - Fax:858-225-8320
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28696111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician