Provider Demographics
NPI:1346697802
Name:MAHLLER, DANIELLE (DPM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MAHLLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:KOCHAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:22606 VALERIO ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9017 RESEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3969
Practice Address - Country:US
Practice Address - Phone:818-885-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5556213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program