Healthcare Provider Details

I. General information

NPI: 1689679045
Provider Name (Legal Business Name): DANIEL E HARDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W L ST
LOS BANOS CA
93635-3953
US

IV. Provider business mailing address

801 W L ST
LOS BANOS CA
93635-3953
US

V. Phone/Fax

Practice location:
  • Phone: 209-827-3303
  • Fax: 209-827-3743
Mailing address:
  • Phone: 209-826-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG77650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: