Healthcare Provider Details

I. General information

NPI: 1457374571
Provider Name (Legal Business Name): DANIEL HULTMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S HARBOR BLVD STE A
LA HABRA CA
90631-7577
US

IV. Provider business mailing address

1400 S HARBOR BLVD STE A
LA HABRA CA
90631-7577
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-3400
  • Fax: 714-441-1998
Mailing address:
  • Phone: 714-879-3400
  • Fax: 714-441-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA21067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: