Healthcare Provider Details

I. General information

NPI: 1730935230
Provider Name (Legal Business Name): DANIELLE SEPULVEDA VIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S CENTER ST
RENO NV
89501-2103
US

IV. Provider business mailing address

350 S CENTER ST
RENO NV
89501-2103
US

V. Phone/Fax

Practice location:
  • Phone: 775-225-5322
  • Fax:
Mailing address:
  • Phone: 775-225-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberIC-2413
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: