Healthcare Provider Details

I. General information

NPI: 1861515280
Provider Name (Legal Business Name): DANIEL SHERMAN ZISOOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 CAMINITO CARMEL LNDG
SAN DIEGO CA
92130-2507
US

IV. Provider business mailing address

11975 EL CAMINO REAL STE 105
SAN DIEGO CA
92130-2991
US

V. Phone/Fax

Practice location:
  • Phone: 858-876-0073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberAFE76794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: