Healthcare Provider Details

I. General information

NPI: 1598692972
Provider Name (Legal Business Name): DANIELLE KHALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GREEN RIVER RD STE 113D
CORONA CA
92878-9185
US

IV. Provider business mailing address

33223 WILLOW TREE LN
WILDOMAR CA
92595-8220
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-2087
  • Fax:
Mailing address:
  • Phone: 925-915-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: