Healthcare Provider Details

I. General information

NPI: 1033702634
Provider Name (Legal Business Name): DANIELLE SHERIE CARR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 KEARNY MESA RD
SAN DIEGO CA
92111-1303
US

IV. Provider business mailing address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

V. Phone/Fax

Practice location:
  • Phone: 619-717-2363
  • Fax: 714-327-0673
Mailing address:
  • Phone: 714-881-0427
  • Fax: 714-327-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: