Healthcare Provider Details

I. General information

NPI: 1578199527
Provider Name (Legal Business Name): DANIELLE GHASSEMLOU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 MISSOURI FLAT RD
PLACERVILLE CA
95667-6269
US

IV. Provider business mailing address

312 N ALMA SCHOOL RD STE 11
CHANDLER AZ
85224-4354
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax:
Mailing address:
  • Phone: 814-853-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8466
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4942
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: