Healthcare Provider Details

I. General information

NPI: 1740349893
Provider Name (Legal Business Name): DANIEL SHIRBROUN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7293 DUMOSA AVE #7
YUCCA VALLEY CA
92284-3700
US

IV. Provider business mailing address

PO BOX 1105
YUCCA VALLEY CA
92286-1105
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-7166
  • Fax: 760-369-7167
Mailing address:
  • Phone: 760-369-7166
  • Fax: 760-369-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: