MEDICARE: DEANNA LOUISE DANIELS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	C37026	CA
2	208D00000X	General Practice Physician	37026	CA
3	2084P0800X	Psychiatry Physician	C37026	CA

General Provider Information

NPI Number	:	1548596448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LOUISE DANIELS MD

Provider Business Mailing Address
First Line	:	19843 NORDHOFF ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3331
Country	:	US
Telephone Number	:	818-783-1425
Fax Number	:	818-995-0901

Provider Business Practice Location Address
First Line	:	19843 NORDHOFF ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3331
Country	:	US
Telephone Number	:	818-783-1425
Fax Number	:	818-995-0901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	12/29/2021

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