Individual
DANIELLE DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 SPRING ST, APT. 10, LA MESA, CA 91941-7967
(831) 524-3704
Mailing address
4201 SPRING ST, APT. 10, LA MESA, CA 91941-7967
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
F2576131
CA
Other
Enumeration date
12/01/2014
Last updated
12/01/2014
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