Provider Demographics
NPI:1215525266
Name:LANGSTON, DANIELLE TERESE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TERESE
Last Name:LANGSTON
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 1:1201 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3118
Mailing Address - Country:US
Mailing Address - Phone:805-679-1189
Mailing Address - Fax:
Practice Address - Street 1:1201 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3118
Practice Address - Country:US
Practice Address - Phone:805-679-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1916175F00000X
CAND1215175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath