Healthcare Provider Details

I. General information

NPI: 1356713648
Provider Name (Legal Business Name): DANIELLE DAVAROS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE ST STE 419
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

6399 SAN IGNACIO AVE STE 120
SAN JOSE CA
95119-1215
US

V. Phone/Fax

Practice location:
  • Phone: 415-678-5887
  • Fax: 415-829-8897
Mailing address:
  • Phone: 408-369-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: