Healthcare Provider Details

I. General information

NPI: 1063560571
Provider Name (Legal Business Name): DANIEL EDWIN HUMPHRIES RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ROSE DR
PLACENTIA CA
92870-3802
US

IV. Provider business mailing address

727 N PHILADELPHIA ST
ANAHEIM CA
92805-2738
US

V. Phone/Fax

Practice location:
  • Phone: 714-524-4817
  • Fax:
Mailing address:
  • Phone: 714-774-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number530824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: