Healthcare Provider Details

I. General information

NPI: 1215902226
Provider Name (Legal Business Name): DANIEL ALLEN NADEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 150
NEWPORT BEACH CA
92663-3663
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200B
NEWPORT BEACH CA
92663-3665
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3001
  • Fax: 949-791-3096
Mailing address:
  • Phone: 949-791-3001
  • Fax: 949-791-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11513
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11513
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number013924
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG88930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: