Provider Demographics
NPI:1295251585
Name:FRIDLEY, DANIEL C
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:FRIDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 PAJARO ST STE D
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3400
Mailing Address - Country:US
Mailing Address - Phone:831-800-7530
Mailing Address - Fax:
Practice Address - Street 1:339 PAJARO ST STE D
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3400
Practice Address - Country:US
Practice Address - Phone:831-800-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90168104100000X
390200000X
CA1113851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program