=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104387810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL OJALA DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2019
-----------------------------------------------------
Last Update Date | 08/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 HOSPITAL DR
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482-4533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-463-8011
-----------------------------------------------------
Fax | 707-463-8044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14300 ORCHARD PKWY, 1 ST FLOOR
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-430-5560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 20A22828
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------