Provider Demographics
NPI:1891080222
Name:WALLACH, DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WALLACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LITTLE RAVEN ST
Mailing Address - Street 2:APT #522
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7163
Mailing Address - Country:US
Mailing Address - Phone:954-579-1127
Mailing Address - Fax:
Practice Address - Street 1:2356 MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8410
Practice Address - Country:US
Practice Address - Phone:303-649-3380
Practice Address - Fax:303-649-3381
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55756207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology