Healthcare Provider Details

I. General information

NPI: 1740407444
Provider Name (Legal Business Name): DANIEL DAVID GEORGE MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 LINCOLN BLVD
SANTA MONICA CA
90401-1730
US

IV. Provider business mailing address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax: 310-450-2024
Mailing address:
  • Phone: 310-314-6200
  • Fax: 310-450-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: