Healthcare Provider Details

I. General information

NPI: 1053668350
Provider Name (Legal Business Name): DAYNE ARVIN A. MENARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY SUITE 610
OAKLAND CA
94612-2041
US

IV. Provider business mailing address

3553 HUSCH WAY
RANCHO CORDOVA CA
95670-6984
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-9065
  • Fax: 510-628-9068
Mailing address:
  • Phone: 916-337-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: