Healthcare Provider Details

I. General information

NPI: 1063083376
Provider Name (Legal Business Name): TAYLOR DANIELLE MARIENTHAL LM,CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR DANIELLE STICE LM, CPM

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 17TH ST
COSTA MESA CA
92627-4512
US

IV. Provider business mailing address

7106 E BREIGHTON CIR
ORANGE CA
92869-2317
US

V. Phone/Fax

Practice location:
  • Phone: 714-878-1938
  • Fax: 714-707-4115
Mailing address:
  • Phone: 714-878-1938
  • Fax: 714-707-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: