Healthcare Provider Details

I. General information

NPI: 1124591441
Provider Name (Legal Business Name): DANIEL MCDANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 10/24/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E PALMDALE BLVD STE I
PALMDALE CA
93550-4949
US

IV. Provider business mailing address

921 W AVENUE J STE C
LANCASTER CA
93534-3443
US

V. Phone/Fax

Practice location:
  • Phone: 909-957-4265
  • Fax:
Mailing address:
  • Phone: 323-472-1953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100874
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW100874
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100874
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: