Provider Demographics
NPI:1619476165
Name:BAGUNU, DANIELLE SANDICO
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SANDICO
Last Name:BAGUNU
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:SANDICO
Other - Last Name:BAGUNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5111 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5111 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3343
Practice Address - Country:US
Practice Address - Phone:925-596-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CAF7374048106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician