Provider Demographics
NPI:1548054604
Name:WHITTLE, DANIELLA ROSE
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:ROSE
Last Name:WHITTLE
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 1:41680 LILLEY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9007
Mailing Address - Country:US
Mailing Address - Phone:559-631-6613
Mailing Address - Fax:
Practice Address - Street 1:35686 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-8744
Practice Address - Country:US
Practice Address - Phone:559-631-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty