1982880845 NPI number — DANIEL URIBE MD A PROFESSIONAL CORPORATION

Table of content: (NPI 1982880845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982880845 NPI number — DANIEL URIBE MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL URIBE MD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAN MARCOS MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982880845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13307 SAN ANTONIO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90650-2970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-807-1877
Provider Business Mailing Address Fax Number:
562-868-6795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13307 SAN ANTONIO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90650-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-807-1877
Provider Business Practice Location Address Fax Number:
562-868-6795
Provider Enumeration Date:
01/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
URIBE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-807-1877

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A42095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A420950 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".