Healthcare Provider Details

I. General information

NPI: 1699246231
Provider Name (Legal Business Name): DANIELE PHYLLICIA MAYBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7697 MADISON AVE
CITRUS HEIGHTS CA
95610-7516
US

IV. Provider business mailing address

4980 HILLSDALE CIR STE A
EL DORADO HILLS CA
95762-5726
US

V. Phone/Fax

Practice location:
  • Phone: 279-233-4848
  • Fax:
Mailing address:
  • Phone: 916-607-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberD7607406
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: