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General NPI Number Information
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NPI Number | 1225343320
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Entity Type | Organization
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Legal Business Name | DANIEL B. CHANNELL, M.D., INC.
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 600 N MOUNTAIN AVE SUITE C102
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City | UPLAND
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State | CA
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Zip | 91786-4359
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Country | US
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Telephone | 909-981-4955
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Fax | 909-981-9463
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Provider Business Mailing Address
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Address Line | 600 N MOUNTAIN AVE SUITE C102
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City | UPLAND
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State | CA
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Zip | 91786-4359
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Country | US
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Telephone | 909-981-4955
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Fax | 909-981-9463
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. DANIEL BROOK CHANNELL
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Credential | M.D.
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Telephone | 909-981-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G85321
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License Number State | CA
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