Provider Demographics
NPI:1962120907
Name:CALVILLO, DANIELLE ASHLEY
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:CALVILLO
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 1:2760 LANTIS LN
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4915
Mailing Address - Country:US
Mailing Address - Phone:530-350-0116
Mailing Address - Fax:
Practice Address - Street 1:6390 RUNNYMEADE DR STE B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8623
Practice Address - Country:US
Practice Address - Phone:530-291-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277840164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse