Healthcare Provider Details

I. General information

NPI: 1063653962
Provider Name (Legal Business Name): SALVATORE A. DANNA, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE SUITE 502
DOWNEY CA
90241-5026
US

IV. Provider business mailing address

11411 BROOKSHIRE AVE SUITE 502
DOWNEY CA
90241-5026
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-9975
  • Fax: 562-923-9447
Mailing address:
  • Phone: 562-622-9975
  • Fax: 562-923-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC36260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15685
License Number StateCA

VIII. Authorized Official

Name: DR. SALVATORE ANTHONY DANNA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 562-622-7216