Healthcare Provider Details

I. General information

NPI: 1437128972
Provider Name (Legal Business Name): DANIEL P MOLDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 2877
LA MESA CA
91943-2877
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4492
  • Fax:
Mailing address:
  • Phone: 619-977-9392
  • Fax: 619-441-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberG40680
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG40680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: