Healthcare Provider Details

I. General information

NPI: 1770584534
Provider Name (Legal Business Name): DANIEL PRESTON FLANIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 320
ORANGE CA
92868-4303
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 320
ORANGE CA
92868-4303
US

V. Phone/Fax

Practice location:
  • Phone: 714-560-4450
  • Fax: 714-560-4455
Mailing address:
  • Phone: 714-560-4450
  • Fax: 714-560-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG063532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: