Healthcare Provider Details

I. General information

NPI: 1235954033
Provider Name (Legal Business Name): CALEEN DANON GC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALEEN BLACKMAN

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 N PASADENA AVE FL 8
PASADENA CA
91103-3670
US

IV. Provider business mailing address

3179 MATARO ST
PASADENA CA
91107-3131
US

V. Phone/Fax

Practice location:
  • Phone: 626-381-5974
  • Fax:
Mailing address:
  • Phone: 626-264-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: