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General NPI Number Information
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NPI Number | 1417135294
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Entity Type | Organization
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Legal Business Name | DANIEL GARDNER, MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 4550 KEARNY VILLA RD SUITE 214
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City | SAN DIEGO
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State | CA
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Zip | 92123-1578
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Country | US
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Telephone | 858-560-5609
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Fax | 858-560-5609
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Provider Business Mailing Address
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Address Line | 4550 KEARNY VILLA RD SUITE 214
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City | SAN DIEGO
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State | CA
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Zip | 92123-1578
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Country | US
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Telephone | 858-560-5609
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Fax | 858-560-5609
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL GARDNER
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Credential | M.D.
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Telephone | 858-560-5609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G27104
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License Number State | CA
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