Provider Demographics
NPI:1659066306
Name:GLOVER, DANIKA LARAY (BS)
Entity Type:Individual
Prefix:
First Name:DANIKA
Middle Name:LARAY
Last Name:GLOVER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:DANIKA
Other - Middle Name:LARAY-LONGINO
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36909 BUCCELLA LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6361
Mailing Address - Country:US
Mailing Address - Phone:714-658-3235
Mailing Address - Fax:
Practice Address - Street 1:36909 BUCCELLA LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-6361
Practice Address - Country:US
Practice Address - Phone:714-658-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-00022542246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy