Healthcare Provider Details

I. General information

NPI: 1700794989
Provider Name (Legal Business Name): MR. DAVID K CANTRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 DE SOTO AVE STE 132
WOODLAND HILLS CA
91367-5102
US

IV. Provider business mailing address

20420 MANDELL ST
WINNETKA CA
91306-1328
US

V. Phone/Fax

Practice location:
  • Phone: 818-257-9496
  • Fax:
Mailing address:
  • Phone: 818-257-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number27041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: