Provider Demographics
NPI:1235670613
Name:SEPEHRI, DANIELLE RENE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENE
Last Name:SEPEHRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:SEPEHRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4000 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7420
Mailing Address - Country:US
Mailing Address - Phone:916-342-4823
Mailing Address - Fax:
Practice Address - Street 1:4000 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7420
Practice Address - Country:US
Practice Address - Phone:916-342-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant