Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A111195 | CA |
NPI | 1811105570 |
---|---|
Provider Name | Candice Odette Mcdaniel |
First Address | Sacramento, CA 95817-2215 |
Second Address | Sacramento, CA 95817-2215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 16/07/2015 |