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NPI Code Detail

MEDICARE: DANIELLE KNACK

MEDICARE: DANIELLE KNACK
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
11041C0700XClinical Social Worker24692CA

General Provider Information

NPI Number : 1679606511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE KNACK
Provider Business Mailing Address
First Line : PO BOX 151461
Second Line :
City : SAN DIEGO
State : CA
Zip : 92175-1461
Country : US
Telephone Number : 619-929-8929
Fax Number :
Provider Business Practice Location Address
First Line : 5650 MOUNT ACKERLY DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-4016
Country : US
Telephone Number : 858-292-9523
Fax Number : 858-292-9529
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 01/20/2012

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Directions to “ DANIELLE KNACK ” Practice Location

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