Healthcare Provider Details

I. General information

NPI: 1609463678
Provider Name (Legal Business Name): DAENIELLE FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39139 10TH ST E
PALMDALE CA
93550-3419
US

IV. Provider business mailing address

43811 SONDI DR
LANCASTER CA
93536-7183
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-7191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: