Provider Demographics
NPI:1649990300
Name:ALDA, DANIEL JR (EXEMPTFROMLICENSURE)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ALDA
Suffix:JR
Gender:M
Credentials:EXEMPTFROMLICENSURE
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:ALDA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:EXEMPTFROMLICENCSURE
Mailing Address - Street 1:11001 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3102
Mailing Address - Country:US
Mailing Address - Phone:909-507-1794
Mailing Address - Fax:
Practice Address - Street 1:11001 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3102
Practice Address - Country:US
Practice Address - Phone:909-507-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid