Healthcare Provider Details

I. General information

NPI: 1487057063
Provider Name (Legal Business Name): DANIEL KULJIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6380
  • Fax:
Mailing address:
  • Phone: 805-934-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: