Provider Demographics
NPI:1154436814
Name:MONGIANO, DANIEL O (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:MONGIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42220 10TH ST W
Mailing Address - Street 2:STE 109
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7075
Mailing Address - Country:US
Mailing Address - Phone:661-951-9195
Mailing Address - Fax:661-951-0024
Practice Address - Street 1:42220 10TH ST W
Practice Address - Street 2:STE 109
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7075
Practice Address - Country:US
Practice Address - Phone:661-951-9195
Practice Address - Fax:661-951-0024
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549030Medicaid
CAA54903Medicare ID - Type Unspecified
CA00A549030Medicaid
CAG17941Medicare UPIN