Provider Demographics
NPI:1013310028
Name:PRUZAN, DANIELA (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:PRUZAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11838 DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8921
Mailing Address - Country:US
Mailing Address - Phone:530-797-6857
Mailing Address - Fax:
Practice Address - Street 1:316 S AUBURN ST
Practice Address - Street 2:STE 3
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7298
Practice Address - Country:US
Practice Address - Phone:530-797-6857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770869711OtherNPI