Healthcare Provider Details

I. General information

NPI: 1649245176
Provider Name (Legal Business Name): DANIEL P. PELLEGRINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 4TH ST
SAUSALITO CA
94965-2409
US

IV. Provider business mailing address

302 4TH ST
SAUSALITO CA
94965-2409
US

V. Phone/Fax

Practice location:
  • Phone: 510-220-9384
  • Fax:
Mailing address:
  • Phone: 510-220-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG88091
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD062510L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: