Healthcare Provider Details

I. General information

NPI: 1538077193
Provider Name (Legal Business Name): BRANAYIA DANIELLE THOMAS-MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANAYIA DANIELLE THOMAS

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

IV. Provider business mailing address

431 S BURNSIDE AVE APT 2A
LOS ANGELES CA
90036-5340
US

V. Phone/Fax

Practice location:
  • Phone: 909-577-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 626-577-2261
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: