Provider Demographics
NPI:1083144398
Name:ROBICHAUD, DANIELLE (LMT, HHP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ROBICHAUD
Suffix:
Gender:F
Credentials:LMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 ESSEX ST.
Mailing Address - Street 2:8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-865-8348
Mailing Address - Fax:
Practice Address - Street 1:1281 UNIVERSITY AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7305
Practice Address - Country:US
Practice Address - Phone:619-800-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist