Provider Demographics
NPI:1689782013
Name:DAVIDSON-MCBEAN, DANIELLE L
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:L
Last Name:DAVIDSON-MCBEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 NORTH LABREA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1708
Mailing Address - Country:US
Mailing Address - Phone:310-419-3378
Mailing Address - Fax:310-419-3401
Practice Address - Street 1:110 NORTH LABREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1708
Practice Address - Country:US
Practice Address - Phone:310-419-3378
Practice Address - Fax:310-419-3401
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87599207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine