Healthcare Provider Details

I. General information

NPI: 1164427944
Provider Name (Legal Business Name): DANIEL JEROME TROZAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 FLORIDA AVE STE 201
MODESTO CA
95350-4400
US

IV. Provider business mailing address

1444 FLORIDA AVE STE 201
MODESTO CA
95350-4400
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4384
  • Fax:
Mailing address:
  • Phone: 209-526-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC34265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: