Provider Demographics
NPI:1043485881
Name:MCDANNEL, RENEE PAULA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:PAULA
Last Name:MCDANNEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2231
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-7231
Mailing Address - Country:US
Mailing Address - Phone:714-625-8667
Mailing Address - Fax:
Practice Address - Street 1:6340 VARIEL AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2514
Practice Address - Country:US
Practice Address - Phone:818-888-4559
Practice Address - Fax:818-888-4005
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6675171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist