Provider Demographics
NPI:1750466181
Name:WELLS, DANIELLE DIANA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:DIANA
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4602
Mailing Address - Country:US
Mailing Address - Phone:714-252-5016
Mailing Address - Fax:
Practice Address - Street 1:10165 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4602
Practice Address - Country:US
Practice Address - Phone:714-252-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical