Provider Demographics
NPI:1669886206
Name:DANI, SVETLANA (MD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:DANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:PUSTILNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:221 E HACIENDA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6625
Mailing Address - Country:US
Mailing Address - Phone:408-376-3350
Mailing Address - Fax:408-374-4130
Practice Address - Street 1:221 E HACIENDA AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6625
Practice Address - Country:US
Practice Address - Phone:408-376-3350
Practice Address - Fax:408-374-4130
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163484207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty