MEDICARE: ALEXIS HALEY DANIELS

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	124Q00000X	Dental Hygienist	33567	CA

General Provider Information

NPI Number	:	1659988004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS HALEY DANIELS

Provider Business Mailing Address
First Line	:	2297 SADIE LN UNIT 226
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-7817
Country	:	US
Telephone Number	:	530-519-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 W EAST AVE STE H
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-7239
Country	:	US
Telephone Number	:	530-342-6065
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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