Healthcare Provider Details

I. General information

NPI: 1982934774
Provider Name (Legal Business Name): JAMES ROBERT DANIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 OAKMONT PL
NIPOMO CA
93444-5711
US

IV. Provider business mailing address

1142 OAKMONT PL
NIPOMO CA
93444-5711
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-3313
  • Fax: 805-929-3313
Mailing address:
  • Phone: 805-929-3313
  • Fax: 805-929-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD-3194
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: