Provider Demographics
NPI:1649765272
Name:CUMBA, DANIEL ELLIS
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ELLIS
Last Name:CUMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8614
Mailing Address - Country:US
Mailing Address - Phone:305-562-3268
Mailing Address - Fax:
Practice Address - Street 1:9200 NW 39TH AVE STE 130-1020
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7331
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18-58924103K00000X
FL1-23-67996103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst