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General NPI Number Information
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NPI Number | 1851815104
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Entity Type | Individual
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Provider Name | DANIELLE STARK PA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 500 SUPERIOR AVE STE 335
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3657
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Country | US
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Telephone | 949-706-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 415 TOWNSQUARE LN APT 127
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-4695
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Country | US
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Telephone | 305-790-7003
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 53436
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 53436
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License Number State | CA
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