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General NPI Number Information
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NPI Number | 1659144954
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Entity Type | Individual
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Provider Name | DANIEL BLACK
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Gender | Male
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 1851 MELANIE CT
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City | SANTA MARIA
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State | CA
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Zip | 93454-5505
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Country | US
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Telephone | 805-325-0042
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Fax |
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Provider Business Mailing Address
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Address Line | 14342 TILDEN ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-5139
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA64104
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License Number State | CA
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