MEDICARE: JULIE DANIEL

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	103K00000X	Behavior Analyst	BEH-000663	AZ

General Provider Information

NPI Number	:	1568122703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE DANIEL

Provider Business Mailing Address
First Line	:	21600 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	8770 N THORNYDALE RD STE 170
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9096
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

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

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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