Provider Demographics
NPI:1225159635
Name:ARDOLINO, DANIELLE KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHLEEN
Last Name:ARDOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:KATHLEEN
Other - Last Name:ARDOLINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:311 S MEDIO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3913
Mailing Address - Country:US
Mailing Address - Phone:310-210-1228
Mailing Address - Fax:
Practice Address - Street 1:1916 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3413
Practice Address - Country:US
Practice Address - Phone:323-526-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine