Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E5516 | CA |
Y | 222Z00000X | Podiatrist | E5516 | CA |
NPI | 1043667488 |
---|---|
Provider Name | Matthew Daniel |
First Address | Valley Village, CA 91607-2355 |
Second Address | Valley Village, CA 91607-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 17/12/2021 |