Healthcare Provider Details

I. General information

NPI: 1568343747
Provider Name (Legal Business Name): DANIELLE BANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 S NOGALES ST
WEST COVINA CA
91792-3056
US

IV. Provider business mailing address

17800 COLIMA RD APT 808
ROWLAND HEIGHTS CA
91748-1746
US

V. Phone/Fax

Practice location:
  • Phone: 833-831-8946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: