Healthcare Provider Details

I. General information

NPI: 1184800591
Provider Name (Legal Business Name): JOHN D. DANIELS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JD DANIELS PHD

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 BRETMOOR WAY UNIT 2
SAN JOSE CA
95129-2967
US

IV. Provider business mailing address

1144 BRETMOOR WAY
SAN JOSE CA
95129-2967
US

V. Phone/Fax

Practice location:
  • Phone: 650-935-2171
  • Fax:
Mailing address:
  • Phone: 650-935-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY120090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: