MEDICARE: DANIELLE GIMROTH

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	103K00000X	Behavior Analyst	1-17-25780	CA

General Provider Information

NPI Number	:	1811420490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE GIMROTH

Provider Business Mailing Address
First Line	:	PO BOX 5157
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95352-5157
Country	:	US
Telephone Number	:	209-572-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	4196 DOUGLAS BLVD STE 100
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-5904
Country	:	US
Telephone Number	:	916-489-1376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	11/02/2021

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Directions to “ DANIELLE GIMROTH ” Practice Location

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