Provider Demographics
NPI:1336491984
Name:DANIEL, STEPHANIE MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIA
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1700 SHATTUCK AVE
Mailing Address - Street 2:#177
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-3402
Mailing Address - Country:US
Mailing Address - Phone:510-848-8585
Mailing Address - Fax:510-803-5657
Practice Address - Street 1:2144 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2668
Practice Address - Country:US
Practice Address - Phone:415-390-2060
Practice Address - Fax:415-466-8031
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice