Healthcare Provider Details

I. General information

NPI: 1255189445
Provider Name (Legal Business Name): DANIEL ALLEN MARTELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 FAIRLAKE
IRVINE CA
92614-7553
US

IV. Provider business mailing address

64 FAIRLAKE
IRVINE CA
92614-7553
US

V. Phone/Fax

Practice location:
  • Phone: 949-230-1551
  • Fax:
Mailing address:
  • Phone: 949-230-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY15694
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY15694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: