Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 269764 | MA |
N | 207P00000X | Emergency Physician | A126241 | CA |
N | 207PP0204X | Pediatric Emergency Physician | 269764 | MA |
Y | 207PP0204X | Pediatric Emergency Physician | A126241 | CA |
NPI | 1366761959 |
---|---|
Provider Name | Michele A Mcdaniel |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2010 |
Last Update Date | 08/11/2019 |