Healthcare Provider Details

I. General information

NPI: 1629531835
Provider Name (Legal Business Name): DANIELLE STRAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5855
  • Fax:
Mailing address:
  • Phone: 858-966-5855
  • Fax: 858-966-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR77398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: