Provider Demographics
NPI:1174646657
Name:BERRY, DANIELL LYNN (EMT, MHW I)
Entity Type:Individual
Prefix:
First Name:DANIELL
Middle Name:LYNN
Last Name:BERRY
Suffix:
Gender:F
Credentials:EMT, MHW I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286-1325
Mailing Address - Country:US
Mailing Address - Phone:760-401-2870
Mailing Address - Fax:
Practice Address - Street 1:58967 BUSINESS CENTER DR
Practice Address - Street 2:SUITE H
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7308
Practice Address - Country:US
Practice Address - Phone:760-401-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAE17924146N00000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered374700000XNursing Service Related ProvidersTechnician