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General NPI Number Information
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NPI Number | 1679936942
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Entity Type | Individual
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Provider Name | DANIELLE VANDERET
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Gender | Female
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1150 N INDIAN CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4872
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Country | US
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Telephone | 760-323-6316
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 N CRESCENT HEIGHTS BLVD APT 201
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5060
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Country | US
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Telephone | 702-708-8663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DO2952
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License Number State | NV
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