Provider Demographics
NPI:1023680014
Name:DANNER, KAITLYN (MD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:DANNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SPRING RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1298
Mailing Address - Country:US
Mailing Address - Phone:805-523-5400
Mailing Address - Fax:
Practice Address - Street 1:612 SPRING RD BLDG A
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1298
Practice Address - Country:US
Practice Address - Phone:805-523-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA197517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine