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General NPI Number Information
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NPI Number | 1053543082
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Entity Type | Individual
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Provider Name | SUGGANTH DANIEL MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2009
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 33608 ORTEGA HWY
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2042
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Country | US
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Telephone | 949-728-4126
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LATTICE # A
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City | IRVINE
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State | CA
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Zip | 92603-0682
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Country | US
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Telephone | 646-957-7857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | A114740
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License Number State | CA
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