Provider Demographics
NPI:1215704838
Name:EPPERSON, DAISHAN MONAE
Entity type:Individual
Prefix:MISS
First Name:DAISHAN
Middle Name:MONAE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:MONAE
Other - Last Name:EPPERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3431 W 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4316
Mailing Address - Country:US
Mailing Address - Phone:714-909-8507
Mailing Address - Fax:
Practice Address - Street 1:3431 W 67TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4316
Practice Address - Country:US
Practice Address - Phone:714-909-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula