Healthcare Provider Details

I. General information

NPI: 1982947610
Provider Name (Legal Business Name): DANIELLE DONDIEGO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 GATEWAY BLVD STE 120
SOUTH SAN FRANCISCO CA
94080-7066
US

IV. Provider business mailing address

3776 US HIGHWAY 17 PO BOX 640
SAVANNAH GA
31404
US

V. Phone/Fax

Practice location:
  • Phone: 650-761-4056
  • Fax:
Mailing address:
  • Phone: 912-350-7020
  • Fax: 912-459-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16564
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number074676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: