MEDICARE: DR. DANIEL J CARUSILLO M.D.

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	207L00000X	Anesthesiology Physician	G75753	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	:	1710956719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J CARUSILLO M.D.

Provider Business Mailing Address
First Line	:	210 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3807
Country	:	US
Telephone Number	:	800-883-7243
Fax Number	:	714-647-1245

Provider Business Practice Location Address
First Line	:	3444 KEARNY VILLA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1960
Country	:	US
Telephone Number	:	858-268-3566
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/14/2011

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