Healthcare Provider Details

I. General information

NPI: 1487036364
Provider Name (Legal Business Name): DANIEL S PETERSEN CATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 ARNOLD DR STE 102
MARTINEZ CA
94553-4190
US

IV. Provider business mailing address

1340 ARNOLD DR STE 110
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-9562
  • Fax:
Mailing address:
  • Phone: 925-313-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: