Healthcare Provider Details

I. General information

NPI: 1245660091
Provider Name (Legal Business Name): TIRTHA MENDAKE D.C, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TOWNSEND ST STE 275
SAN FRANCISCO CA
94107-1600
US

IV. Provider business mailing address

994 DE HARO ST
SAN FRANCISCO CA
94107-2708
US

V. Phone/Fax

Practice location:
  • Phone: 415-578-8781
  • Fax:
Mailing address:
  • Phone: 415-578-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number31601
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: