Healthcare Provider Details

I. General information

NPI: 1124021969
Provider Name (Legal Business Name): DANIEL F MULVIHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD SUITE 580
POWAY CA
92064-2437
US

IV. Provider business mailing address

PO BOX 28199
SAN DIEGO CA
92198-0199
US

V. Phone/Fax

Practice location:
  • Phone: 858-592-2696
  • Fax: 760-743-8837
Mailing address:
  • Phone: 858-673-2574
  • Fax: 858-618-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG55384
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG55384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: