=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942762299
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. DANESSA MAYO, PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1190 LINCOLN AVE STE 7
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-882-1498
-----------------------------------------------------
Fax | 408-504-1435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1190 LINCOLN AVE STE 7
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-3036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-882-1498
-----------------------------------------------------
Fax | 408-504-1435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. DANESSA MAYO
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 408-882-1498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------