Healthcare Provider Details

I. General information

NPI: 1184373714
Provider Name (Legal Business Name): DANIELLE TAYLOR ESTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTH STATE STREET CT-A7D
LOS ANGELES CA
90089
US

IV. Provider business mailing address

351 DOUGLAS ST APT H
LOS ANGELES CA
90026-6955
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-2324
  • Fax:
Mailing address:
  • Phone: 206-979-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA189725
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA189725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: