Provider Demographics
NPI:1114750064
Name:CROUCH, DANNIELLE AMBER
Entity type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:AMBER
Last Name:CROUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14760 COOL VALLEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-3827
Mailing Address - Country:US
Mailing Address - Phone:805-452-0648
Mailing Address - Fax:
Practice Address - Street 1:12264 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3060
Practice Address - Country:US
Practice Address - Phone:805-452-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily