Provider Demographics
NPI:1598326399
Name:GARCIA, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GARCIA
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 1:1234 W CHAPMAN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2863
Mailing Address - Country:US
Mailing Address - Phone:714-771-0722
Mailing Address - Fax:
Practice Address - Street 1:1234 W CHAPMAN AVE STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2863
Practice Address - Country:US
Practice Address - Phone:714-771-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2024-05-01
Deactivation Date:2023-10-16
Deactivation Code:
Reactivation Date:2023-11-28
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist