Provider Demographics
NPI:1952457673
Name:DANILLER, AVRON (MD)
Entity Type:Individual
Prefix:
First Name:AVRON
Middle Name:
Last Name:DANILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3506
Mailing Address - Country:US
Mailing Address - Phone:818-345-3338
Mailing Address - Fax:818-345-3363
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-345-3338
Practice Address - Fax:818-345-3363
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC40195208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery