Provider Demographics
NPI:1053116343
Name:WATSON, DANIELLE YVETTE (NVMT12218)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:YVETTE
Last Name:WATSON
Suffix:
Gender:
Credentials:NVMT12218
Other - Prefix:
Other - First Name:MISS MA'AM
Other - Middle Name:GOLDIE
Other - Last Name:LOXX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NVMT12218
Mailing Address - Street 1:4855 BOULDER HWY # F-2080
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3012
Mailing Address - Country:US
Mailing Address - Phone:650-267-1480
Mailing Address - Fax:
Practice Address - Street 1:4855 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3012
Practice Address - Country:US
Practice Address - Phone:510-395-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.12218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist