Healthcare Provider Details

I. General information

NPI: 1669886206
Provider Name (Legal Business Name): SVETLANA DANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SVETLANA PUSTILNIKOVA MD

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HACIENDA AVE STE B
CAMPBELL CA
95008-6625
US

IV. Provider business mailing address

221 E HACIENDA AVE STE B
CAMPBELL CA
95008-6625
US

V. Phone/Fax

Practice location:
  • Phone: 408-376-3350
  • Fax: 408-374-4130
Mailing address:
  • Phone: 408-376-3350
  • Fax: 408-374-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA163484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: