Individual
DR. DANESSA IZA MAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3893 FIANO CMN, FREMONT, CA 94555-2280
(510) 497-0478
Mailing address
3893 FIANO CMN, FREMONT, CA 94555-2280
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY29622
CA
103TC2200X
Clinical Child & Adolescent Psychologist
29622
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D6949774
DRIVER'S LICENSE
CA
Enumeration date
11/04/2014
Last updated
04/11/2023
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