MEDICARE: DANIEL URIBE MD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	23092	CA

General Provider Information

NPI Number	:	1518337088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL URIBE MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	13307 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2970
Country	:	US
Telephone Number	:	562-863-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	13307 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2970
Country	:	US
Telephone Number	:	562-863-0124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL URIBE
Credential	:
Telephone Number	:	562-863-0124

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	09/28/2015

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