Provider Demographics
NPI:1003413873
Name:MCDANIEL, AURY
Entity Type:Individual
Prefix:
First Name:AURY
Middle Name:
Last Name:MCDANIEL
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 1:1068 CAMINO MIEL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8712
Mailing Address - Country:US
Mailing Address - Phone:619-656-9798
Mailing Address - Fax:619-216-0498
Practice Address - Street 1:1068 CAMINO MIEL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8712
Practice Address - Country:US
Practice Address - Phone:619-656-9798
Practice Address - Fax:619-216-0498
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374601040311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home