Provider Demographics
NPI:1427704634
Name:WILCOX, DANIEL PAUL (GRAD STUDENT TRAINEE)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:WILCOX
Suffix:
Gender:M
Credentials:GRAD STUDENT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FAIR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1918
Mailing Address - Country:US
Mailing Address - Phone:714-824-7441
Mailing Address - Fax:
Practice Address - Street 1:960 E GREEN ST STE 280
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2419
Practice Address - Country:US
Practice Address - Phone:714-824-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst