=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053744805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLA RENEE CORREA D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2013
-----------------------------------------------------
Last Update Date | 08/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2858 STEVENS CREEK BLVD STE 208
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-637-8993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 DESCANSO DR UNIT 1328
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95134-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-637-8993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 32519
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------