Provider Demographics
NPI:1821763459
Name:RATH, DANIELLE INEZ
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:INEZ
Last Name:RATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 GARDENIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5847
Mailing Address - Country:US
Mailing Address - Phone:909-641-9109
Mailing Address - Fax:
Practice Address - Street 1:1823 GARDENIA AVE APT A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5847
Practice Address - Country:US
Practice Address - Phone:909-641-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty