Healthcare Provider Details

I. General information

NPI: 1356268213
Provider Name (Legal Business Name): DANIEL VAN STAAVEREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 E OAKMONT AVE
FRESNO CA
93730-5953
US

IV. Provider business mailing address

2426 E OAKMONT AVE
FRESNO CA
93730-5953
US

V. Phone/Fax

Practice location:
  • Phone: 559-288-1390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number252727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: