Provider Demographics
NPI:1194424598
Name:CONTRERAS, DANIELA (PA)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 S CYPRESS BEND DR APT 407
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4434
Mailing Address - Country:US
Mailing Address - Phone:954-682-1553
Mailing Address - Fax:
Practice Address - Street 1:2202 S CYPRESS BEND DR APT 407
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4434
Practice Address - Country:US
Practice Address - Phone:954-682-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant