Healthcare Provider Details

I. General information

NPI: 1326528175
Provider Name (Legal Business Name): DAISY DSUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 E 6TH ST
LOS ANGELES CA
90021-1026
US

IV. Provider business mailing address

849 E 6TH ST
LOS ANGELES CA
90021-1026
US

V. Phone/Fax

Practice location:
  • Phone: 213-623-8446
  • Fax: 213-896-1880
Mailing address:
  • Phone: 213-623-8446
  • Fax: 213-896-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: