Healthcare Provider Details

I. General information

NPI: 1134852650
Provider Name (Legal Business Name): ADAM R DANIELS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-2930
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 424-315-1029
  • Fax:
Mailing address:
  • Phone: 424-315-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95021524
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number95021524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: