MEDICARE: DAYNE ARVIN A. MENARDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1053668350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYNE ARVIN A. MENARDO

Provider Business Mailing Address
First Line	:	3553 HUSCH WAY
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6984
Country	:	US
Telephone Number	:	916-337-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 BROADWAY
Second Line	:	SUITE 610
City	:	OAKLAND
State	:	CA
Zip	:	94612-2041
Country	:	US
Telephone Number	:	510-628-9065
Fax Number	:	510-628-9068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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