Healthcare Provider Details

I. General information

NPI: 1992251409
Provider Name (Legal Business Name): DANIELLE ANNETTE GRIBBEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TUSTIN ST
ORANGE CA
92866-3425
US

IV. Provider business mailing address

26137 LA PAZ RD
MISSION VIEJO CA
92691-5319
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-6373
  • Fax:
Mailing address:
  • Phone: 714-922-4100
  • Fax: 949-768-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95035557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: