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General NPI Number Information
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NPI Number | 1912121328
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Entity Type | Individual
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Provider Name | DIANE MARIE DANIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 S EUCLID AVE SUITE 5
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City | PASADENA
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State | CA
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Zip | 91101-2446
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Country | US
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Telephone | 626-792-2711
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Fax | 626-792-2505
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Provider Business Mailing Address
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Address Line | 130 S. EUCLID AVE. SUITE 5
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City | PASADENA
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State | CA
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Zip | 91101-2446
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Country | US
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Telephone | 626-792-2711
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Fax | 626-792-2505
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | G 058268
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License Number State | CA
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