Provider Demographics
NPI:1043762164
Name:ALBRIGHT, DANIELLE DENIESE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DENIESE
Last Name:ALBRIGHT
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 1:1849 CYMBELINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4974
Mailing Address - Country:US
Mailing Address - Phone:916-474-1411
Mailing Address - Fax:916-774-9440
Practice Address - Street 1:1849 CYMBELINE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4974
Practice Address - Country:US
Practice Address - Phone:916-474-1411
Practice Address - Fax:916-774-9440
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4598020390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program