Healthcare Provider Details

I. General information

NPI: 1124053798
Provider Name (Legal Business Name): DANELLE FISHER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 LATIJERA BLVD
LOS ANGELES CA
90045
US

IV. Provider business mailing address

8725 LATIJERA BLVD
LOS ANGELES CA
90045
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-1455
  • Fax: 310-670-0951
Mailing address:
  • Phone: 310-670-1455
  • Fax: 310-670-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70622
License Number StateCA

VIII. Authorized Official

Name: MS. DANELLE M FISHER
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 310-670-1455