Provider Demographics
NPI:1386267169
Name:DANIELS, PATRICIA UNIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:UNIA
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 1:16501 WALNUT ST STE 1216501
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3641
Mailing Address - Country:US
Mailing Address - Phone:760-949-1200
Mailing Address - Fax:
Practice Address - Street 1:16501 WALNUT ST STE 12
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3684
Practice Address - Country:US
Practice Address - Phone:760-949-1200
Practice Address - Fax:760-657-2408
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108970390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOtherAMFT #108970