Provider Demographics
NPI:1639887052
Name:MILLER, DANIELLE PREPON
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PREPON
Last Name:MILLER
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 1:25236 RUNNING HORSE RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3336
Mailing Address - Country:US
Mailing Address - Phone:818-679-4613
Mailing Address - Fax:
Practice Address - Street 1:25236 RUNNING HORSE RD
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-3336
Practice Address - Country:US
Practice Address - Phone:818-679-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist