Provider Demographics
NPI:1831436963
Name:DAVIS-HARDIN, DANIEL JESUS-DUPRIX
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JESUS-DUPRIX
Last Name:DAVIS-HARDIN
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 1:421 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5534
Mailing Address - Country:US
Mailing Address - Phone:510-839-3769
Mailing Address - Fax:510-839-3500
Practice Address - Street 1:421 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5534
Practice Address - Country:US
Practice Address - Phone:510-839-3769
Practice Address - Fax:510-839-3500
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84993106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist