Provider Demographics
NPI:1578362596
Name:FLAMENCO, DANIELLA (AA-C)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:FLAMENCO
Suffix:
Gender:
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9158 MINEOLA CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8261
Mailing Address - Country:US
Mailing Address - Phone:571-485-0633
Mailing Address - Fax:
Practice Address - Street 1:12401 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2548
Practice Address - Country:US
Practice Address - Phone:720-848-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant