Healthcare Provider Details

I. General information

NPI: 1295251585
Provider Name (Legal Business Name): DANIEL C FRIDLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST STE D
SALINAS CA
93901-3400
US

IV. Provider business mailing address

339 PAJARO ST STE D
SALINAS CA
93901-3400
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-7530
  • Fax:
Mailing address:
  • Phone: 831-800-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number90168
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: