Healthcare Provider Details

I. General information

NPI: 1073924650
Provider Name (Legal Business Name): DANIEL NEUDORF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9571 HIGHWAY 9
BEN LOMOND CA
95005-9269
US

IV. Provider business mailing address

PO BOX 903
FELTON CA
95018-0903
US

V. Phone/Fax

Practice location:
  • Phone: 831-216-6156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A14581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A14581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: