Provider Demographics
NPI:1407349541
Name:GAUTHREAUX, DANIELLE L
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:L
Last Name:GAUTHREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2719
Mailing Address - Country:US
Mailing Address - Phone:661-868-7163
Mailing Address - Fax:661-868-7171
Practice Address - Street 1:3715 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2719
Practice Address - Country:US
Practice Address - Phone:661-868-7163
Practice Address - Fax:661-868-7171
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherCASE MANAGER