Provider Demographics
NPI:1346245214
Name:MORCOS-GANNON, DANIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:MORCOS-GANNON
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 1:643 W EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7201
Mailing Address - Country:US
Mailing Address - Phone:530-899-2981
Mailing Address - Fax:530-898-1040
Practice Address - Street 1:643 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7201
Practice Address - Country:US
Practice Address - Phone:530-899-2981
Practice Address - Fax:530-898-1040
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553521Medicaid
CA00A553520Medicare PIN
CA00A553521Medicaid