Individual
DANIELLE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 SUPERIOR AVE STE 335, NEWPORT BEACH, CA 92663-3657
(949) 706-1469
Mailing address
415 TOWNSQUARE LN APT 127, HUNTINGTON BEACH, CA 92648-4695
(305) 790-7003
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
53436
CA
363AS0400X
Surgical Physician Assistant
53436
CA
Other
Enumeration date
07/28/2017
Last updated
07/28/2017
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