MEDICARE: DANIEL GARDNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G27104	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134103591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GARDNER MD

Provider Business Mailing Address
First Line	:	13725 MAR SCENIC DR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3426
Country	:	US
Telephone Number	:	858-560-5609
Fax Number	:	858-560-5609

Provider Business Practice Location Address
First Line	:	4550 KEARNY VILLA RD
Second Line	:	SUITE 214
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1578
Country	:	US
Telephone Number	:	858-560-5609
Fax Number	:	858-560-5609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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