=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093352619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE TOZZO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2019
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6255 LUSK BLVD STE 100
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92121-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-452-3937
-----------------------------------------------------
Fax | 858-452-3933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6201 GREENLEIGH AVE FL 2
-----------------------------------------------------
City | MIDDLE RIVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21220-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-933-2704
-----------------------------------------------------
Fax | 858-452-3933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9112672
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C0009503
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------