Provider Demographics
NPI:1528352481
Name:ANDERSON, DANIELLE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W ALAMEDA AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4814
Mailing Address - Country:US
Mailing Address - Phone:818-847-6990
Mailing Address - Fax:818-847-6938
Practice Address - Street 1:2601 W ALAMEDA AVE STE 212
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-847-6990
Practice Address - Fax:818-847-6938
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571580YNDPOtherMEDICARE - NOVITAS SOLUTIONS
TX370334001Medicaid