Provider Demographics
NPI:1639254915
Name:DANIELA MORCOS-GANNON, MD
Entity Type:Organization
Organization Name:DANIELA MORCOS-GANNON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORCOS-GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-899-2981
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553521Medicaid
CA00A553521Medicaid