Healthcare Provider Details

I. General information

NPI: 1124683628
Provider Name (Legal Business Name): DANIEL REAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20001 S RANCHO WAY
RANCHO DOMINGUEZ CA
90220-6318
US

IV. Provider business mailing address

20001 S RANCHO WAY
RANCHO DOMINGUEZ CA
90220-6318
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3244
  • Fax: 310-698-7040
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA179651
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number326800-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA179651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: