Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A126857 | CA |
N | 207XS0117X | Orthopaedic Spine Surgeon | MD60272416 | WA |
NPI | 1255599015 |
---|---|
Provider Name | Dr. Mathias Wayne Daniels |
First Address | Watsonville, CA 95076-2491 |
Second Address | Watsonville, CA 95076-2491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0294301 | L&I (01) | WA |
1255599015 | (05) | WA |