Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2039 | CA |
Y | 222Z00000X | Podiatrist | E2039 | CA |
NPI | 1063489532 |
---|---|
Provider Name | Dr. Robert A. Daniels |
First Address | Los Osos, CA 93402-3342 |
Second Address | Los Osos, CA 93402-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E20390 | (05) | CA |
00E20391 | (05) | CA |
T11148 | (02) |