MEDICARE: DANIELLE ONSTOT MD, INC.

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
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1770773392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELLE ONSTOT MD, INC.

Provider Business Mailing Address
First Line	:	451 W. GONZALES RD.
Second Line	:	SUITE 260
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-278-7110
Fax Number	:	805-278-7115

Provider Business Practice Location Address
First Line	:	451 W. GONZALES RD.
Second Line	:	SUITE 260
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-278-7110
Fax Number	:	805-278-7115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIELLE ONSTOT
Credential	:	MD
Telephone Number	:	805-278-7110

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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