Healthcare Provider Details

I. General information

NPI: 1679255988
Provider Name (Legal Business Name): DANIEL MICHAEL NOONAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

3653 3RD AVE
LA CRESCENTA CA
91214-2437
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-2304
  • Fax:
Mailing address:
  • Phone: 213-220-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95245903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: