Healthcare Provider Details

I. General information

NPI: 1770325094
Provider Name (Legal Business Name): SAHARA DANIELA HUAZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81369 AVENIDA ALAMITOS
INDIO CA
92201-9108
US

IV. Provider business mailing address

PO BOX 2853
INDIO CA
92202-3553
US

V. Phone/Fax

Practice location:
  • Phone: 760-619-6009
  • Fax:
Mailing address:
  • Phone: 760-619-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: