Provider Demographics
NPI:1093432080
Name:RESENDEZ, DANIEL C
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:RESENDEZ
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 1:41760 IVY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9416
Mailing Address - Country:US
Mailing Address - Phone:951-595-4673
Mailing Address - Fax:
Practice Address - Street 1:41760 IVY ST STE 104
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9416
Practice Address - Country:US
Practice Address - Phone:951-595-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician