Provider Demographics
NPI:1033854450
Name:KRAFT, DANIEL
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:KRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4633
Mailing Address - Country:US
Mailing Address - Phone:949-357-2556
Mailing Address - Fax:
Practice Address - Street 1:840 PALMETTO PL
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4126
Practice Address - Country:US
Practice Address - Phone:714-267-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician