Healthcare Provider Details

I. General information

NPI: 1780673012
Provider Name (Legal Business Name): DANIEL W RHODES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 SORRENTO VALLEY RD SUITE A
SAN DIEGO CA
92121-1643
US

IV. Provider business mailing address

457 ALAMEDA BLVD
CORONADO CA
92118-1614
US

V. Phone/Fax

Practice location:
  • Phone: 760-438-6572
  • Fax:
Mailing address:
  • Phone: 617-306-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number203210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: