Healthcare Provider Details

I. General information

NPI: 1447747787
Provider Name (Legal Business Name): JONATHAN DANIELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

755 E MCDOWELL RD FL 2
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-265-5720
Mailing address:
  • Phone: 602-521-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number77173
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number77173
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2023-0294
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: