Healthcare Provider Details

I. General information

NPI: 1699802538
Provider Name (Legal Business Name): DANIELLE DZUBAK AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W 3RD ST SUITE 111 CARE CENTER
LOS ANGELES CA
90057-1922
US

IV. Provider business mailing address

750 N KINGS RD APT 106
LOS ANGELES CA
90069-5902
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-7475
  • Fax:
Mailing address:
  • Phone: 213-989-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: