Healthcare Provider Details

I. General information

NPI: 1003220989
Provider Name (Legal Business Name): DANIEL JOSEPH DESANTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 01/31/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
OCEANSIDE CA
92055
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 760-716-4061
  • Fax: 760-725-1303
Mailing address:
  • Phone: 619-532-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA139601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: