MEDICARE: DANIEL E. SPENCER 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	208000000X	Pediatrics Physician	C51747	CA

General Provider Information

NPI Number	:	1700953650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL E. SPENCER MD

Provider Business Mailing Address
First Line	:	1011 BALDWIN PARK BLVD
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-5806
Country	:	US
Telephone Number	:	626-851-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN DIEGO LA MESA
Second Line	:	3875 AVACADO BLVD
City	:	LA MESA
State	:	CA
Zip	:	91941
Country	:	US
Telephone Number	:	619-670-2128
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/02/2021

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