Provider Demographics
NPI:1124443684
Name:COBB, DANIEL (DOM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:DOM
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Mailing Address - Street 1:826 CAMINO DE MONTE REY
Mailing Address - Street 2:SUITE B2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3977
Mailing Address - Country:US
Mailing Address - Phone:505-424-9527
Mailing Address - Fax:505-474-5561
Practice Address - Street 1:826 CAMINO DE MONTE REY
Practice Address - Street 2:SUITE B2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3977
Practice Address - Country:US
Practice Address - Phone:505-424-9527
Practice Address - Fax:505-474-5561
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist