Provider Demographics
NPI:1134145154
Name:FISHER, DANELLE M (MD)
Entity Type:Individual
Prefix:MRS
First Name:DANELLE
Middle Name:M
Last Name:FISHER
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 1:12555 W JEFFERSON BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7032
Mailing Address - Country:US
Mailing Address - Phone:424-443-5600
Mailing Address - Fax:424-443-5606
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7032
Practice Address - Country:US
Practice Address - Phone:424-443-5600
Practice Address - Fax:424-443-5606
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics