Individual provider Active NPI

David Norman Mendelmar

  • Clinical Social Worker
  • Davis, CA
National Provider Identifier
1053967406
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
105 E St Ste 2E
Davis, CA 95616-4572
Phone
(707) 254-2656
NPI assigned
Aug 12, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

105 E St Ste 2E
Davis, CA 95616-4572

Mailing address

105 E St Ste 2E
Davis, CA 95616-4572
Phone (707) 254-2656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1053967406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E ST STE 2E",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956164572",
            "telephone_number": "707-254-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E ST STE 2E",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956164572",
            "telephone_number": "707-254-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDELMAR",
        "first_name": "DAVID",
        "middle_name": "NORMAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-12",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.