Healthcare Provider Details

I. General information

NPI: 1346245214
Provider Name (Legal Business Name): DANIELA MORCOS-GANNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W EAST AVE
CHICO CA
95926-7201
US

IV. Provider business mailing address

643 W EAST AVE
CHICO CA
95926-7201
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-2981
  • Fax: 530-898-1040
Mailing address:
  • Phone: 530-899-2981
  • Fax: 530-898-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: