Provider Demographics
NPI:1255188439
Name:STEVENS, DANIEL (RN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 CHEROKEE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3695
Mailing Address - Country:US
Mailing Address - Phone:925-557-8600
Mailing Address - Fax:
Practice Address - Street 1:4180 RUFFIN RD STE 255
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1881
Practice Address - Country:US
Practice Address - Phone:619-291-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95305808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse