MEDICARE: DANIEL PAUL ROGERS

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	163WC0400X	Case Management Registered Nurse	95043872	CA

General Provider Information

NPI Number	:	1255986667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PAUL ROGERS

Provider Business Mailing Address
First Line	:	409 N PACIFIC COAST HWY STE 590
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 N PACIFIC COAST HWY STE 590
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6853
Country	:	US
Telephone Number	:	213-213-5171
Fax Number	:

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

Provider Enumeration Date	:	08/03/2019
Last Update Date	:	08/03/2019

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Directions to “ DANIEL PAUL ROGERS ” Practice Location

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