Provider Demographics
NPI:1124653043
Name:MAYEN, DANIEL JR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MAYEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KARLA WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3911
Mailing Address - Country:US
Mailing Address - Phone:530-687-2489
Mailing Address - Fax:
Practice Address - Street 1:120 KARLA WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3911
Practice Address - Country:US
Practice Address - Phone:530-687-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator