Provider Demographics
NPI:1720222318
Name:MCCLINTON, DANIELLE VALENTINA (LSA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:VALENTINA
Last Name:MCCLINTON
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:STE 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3924
Mailing Address - Country:US
Mailing Address - Phone:210-352-5346
Mailing Address - Fax:210-352-5367
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:STE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3924
Practice Address - Country:US
Practice Address - Phone:210-352-5346
Practice Address - Fax:210-352-5367
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00485246ZC0007X
TX09-288246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12678958OtherCAQH
09-288OtherABSA BOARD CERTIFICATION
TX81NN94OtherBCBS (SASA)
TXSA00485OtherLSA LICENSE