Provider Demographics
NPI:1184925190
Name:GERMON, PATRICIA DANIELAH (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA DANIELAH
Middle Name:
Last Name:GERMON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANIELAH
Other - Middle Name:
Other - Last Name:GERMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:22920 ESTORIL DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-5409
Mailing Address - Country:US
Mailing Address - Phone:714-390-8094
Mailing Address - Fax:
Practice Address - Street 1:22920 ESTORIL DR UNIT 2
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-5409
Practice Address - Country:US
Practice Address - Phone:714-390-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-07
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist