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NPI Code Detail

MEDICARE: DAVID L PELLANDINI HAD

MEDICARE: DAVID L PELLANDINI HAD
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
1237700000XHearing Instrument SpecialistHA2892CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HA2892OTHERCAHA DISPENSER LICENSE

General Provider Information

NPI Number : 1932477460
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID L PELLANDINI HAD
Provider Business Mailing Address
First Line : 103 CYPRESS ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5401
Country : US
Telephone Number : 707-962-9230
Fax Number : 707-962-9230
Provider Business Practice Location Address
First Line : 103 CYPRESS ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5401
Country : US
Telephone Number : 707-962-9230
Fax Number : 707-523-0260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2011
Last Update Date : 09/14/2020

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