Healthcare Provider Details

I. General information

NPI: 1790273514
Provider Name (Legal Business Name): DANIELLE LEAH BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE LEAH GOLDBLATT MS, RD

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

1526 W CORTNER ST
HANFORD CA
93230-8128
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-2399
  • Fax:
Mailing address:
  • Phone: 858-353-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86011956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: