Healthcare Provider Details

I. General information

NPI: 1639895659
Provider Name (Legal Business Name): DANIEL JOSEPH WILLS CHRISTEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 EL CAMINO REAL
SAN CARLOS CA
94070-5208
US

IV. Provider business mailing address

389 ACCACIA ST
DALY CITY CA
94014-1510
US

V. Phone/Fax

Practice location:
  • Phone: 508-179-0706
  • Fax:
Mailing address:
  • Phone: 209-728-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: