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General NPI Number Information
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NPI Number | 1851283337
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Entity Type | Individual
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Provider Name | DANIEL JACOB BOUDAGIAN
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Gender | Male
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 201 ALAMEDA DEL PRADO STE 103
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City | NOVATO
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State | CA
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Zip | 94949-6698
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Country | US
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Telephone | 415-457-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 128 VALLEYVIEW WAY
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5561
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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