Provider Demographics
NPI:1508934209
Name:DANIELS, MARK STEVEN (HAD 0657)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:DANIELS
Suffix:
Gender:M
Credentials:HAD 0657
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6946
Mailing Address - Country:US
Mailing Address - Phone:505-564-9990
Mailing Address - Fax:505-564-9991
Practice Address - Street 1:312 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6946
Practice Address - Country:US
Practice Address - Phone:505-564-9990
Practice Address - Fax:505-564-9991
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0657237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist