MEDICARE: DANIELLE GOODNIGHT

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	172V00000X	Community Health Worker
2	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1942085352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE GOODNIGHT

Provider Business Mailing Address
First Line	:	333 N LANTANA ST STE 259
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9008
Country	:	US
Telephone Number	:	805-910-6338
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N LANTANA ST STE 259
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9008
Country	:	US
Telephone Number	:	805-384-1555
Fax Number	:

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	03/14/2024

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Directions to “ DANIELLE GOODNIGHT ” Practice Location

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