Provider Demographics
NPI:1073704250
Name:SAWYER-MACKNET, DANIELLE CA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CA
Last Name:SAWYER-MACKNET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25805 BARTON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3814
Mailing Address - Country:US
Mailing Address - Phone:909-478-7700
Mailing Address - Fax:909-478-7705
Practice Address - Street 1:25805 BARTON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3814
Practice Address - Country:US
Practice Address - Phone:909-478-7700
Practice Address - Fax:909-478-7705
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91409207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A914090Medicaid
CA00A914090Medicare PIN