Healthcare Provider Details

I. General information

NPI: 1225265481
Provider Name (Legal Business Name): DANIEL JOHN BEBEREIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8893 LA MESA BLVD STE D
LA MESA CA
91942-5448
US

IV. Provider business mailing address

22 RUNNING BROOK DR
COTO DE CAZA CA
92679-5221
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-5111
  • Fax:
Mailing address:
  • Phone: 949-293-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA115593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: