Provider Demographics
NPI:1255189445
Name:MARTELL, DANIEL ALLEN (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
Last Name:MARTELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 FAIRLAKE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7553
Mailing Address - Country:US
Mailing Address - Phone:949-230-1551
Mailing Address - Fax:
Practice Address - Street 1:64 FAIRLAKE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7553
Practice Address - Country:US
Practice Address - Phone:949-230-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15694103G00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist