Provider Demographics
NPI:1750765509
Name:DANNIELLE O. HARWOOD, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:DANNIELLE O. HARWOOD, MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNIELLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-966-2316
Mailing Address - Street 1:702 MANGROVE AVE
Mailing Address - Street 2:#345
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3948
Mailing Address - Country:US
Mailing Address - Phone:530-966-2316
Mailing Address - Fax:
Practice Address - Street 1:2012 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-6727
Practice Address - Country:US
Practice Address - Phone:530-966-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000895261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care