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General NPI Number Information
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NPI Number | 1851432900
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MCDANIEL MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 4058 WILLOWS RD
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City | ALPINE
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State | CA
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Zip | 91901-1668
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Country | US
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Telephone | 619-298-0320
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Fax | 619-497-1886
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Provider Business Mailing Address
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Address Line | PO BOX 16777
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City | SAN DIEGO
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State | CA
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Zip | 92176-6777
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Country | US
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Telephone | 619-298-0320
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Fax | 619-497-1886
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G44642
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License Number State | CA
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