Provider Demographics
NPI:1154374122
Name:DANIELS, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 EMBARCADERO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:ISLA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4869
Mailing Address - Country:US
Mailing Address - Phone:805-968-1511
Mailing Address - Fax:805-685-2467
Practice Address - Street 1:970 EMBARCADERO DEL MAR
Practice Address - Street 2:
Practice Address - City:ISLA VISTA
Practice Address - State:CA
Practice Address - Zip Code:93117-4869
Practice Address - Country:US
Practice Address - Phone:805-968-1511
Practice Address - Fax:805-685-2467
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34858207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G348580Medicaid
CA00G348580Medicaid
CAWG34858EMedicare PIN