Provider Demographics
NPI:1215698444
Name:DANIELS, EDITH Q
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:Q
Last Name:DANIELS
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 1:909 DOVER
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3814
Mailing Address - Country:US
Mailing Address - Phone:510-637-9148
Mailing Address - Fax:
Practice Address - Street 1:909 DOVER
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-3814
Practice Address - Country:US
Practice Address - Phone:510-637-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider