Basic Information
| Provider Information | |||||||||
| NPI: | 1740349893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIRBROUN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1105 | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922861105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603697166 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Practice Location | |||||||||
| Address1: | 7293 DUMOSA AVE | ||||||||
| Address2: | #7 | ||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603697166 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY4161 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.