Provider Demographics
NPI:1902559057
Name:REESCANO, DANIELLE NICOL
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOL
Last Name:REESCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N POST OAK RD APT 4305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7340
Mailing Address - Country:US
Mailing Address - Phone:832-273-2398
Mailing Address - Fax:
Practice Address - Street 1:1255 N POST OAK RD APT 4305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7340
Practice Address - Country:US
Practice Address - Phone:832-273-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile