Healthcare Provider Details

I. General information

NPI: 1023868155
Provider Name (Legal Business Name): MISS CHELSEY AMBER DAQUIOAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39510 PASEO PADRE PKWY STE 190
FREMONT CA
94538-4716
US

IV. Provider business mailing address

6330 THORNTON AVE
NEWARK CA
94560-3734
US

V. Phone/Fax

Practice location:
  • Phone: 510-403-5916
  • Fax:
Mailing address:
  • Phone: 510-689-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: