Healthcare Provider Details

I. General information

NPI: 1366940256
Provider Name (Legal Business Name): DANIELLE CUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41760 IVY ST STE 101
MURRIETA CA
92562-9416
US

IV. Provider business mailing address

41760 IVY ST STE 101
MURRIETA CA
92562-9416
US

V. Phone/Fax

Practice location:
  • Phone: 951-215-6253
  • Fax:
Mailing address:
  • Phone: 951-215-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-28825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: