Healthcare Provider Details

I. General information

NPI: 1154941847
Provider Name (Legal Business Name): CHELSEA KAGAN DANIELS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 COMMERCENTER W
SAN BERNARDINO CA
92408-3303
US

IV. Provider business mailing address

801 E KATELLA AVE
ANAHEIM CA
92805-6614
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-02665
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101278232
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME161899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: