Provider Demographics
NPI:1720143175
Name:VIRNICH, DANIEL EUGENE JR (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EUGENE
Last Name:VIRNICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4060 GLENCOE AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5884
Mailing Address - Country:US
Mailing Address - Phone:303-667-8950
Mailing Address - Fax:
Practice Address - Street 1:4060 GLENCOE AVE APT 306
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5884
Practice Address - Country:US
Practice Address - Phone:303-667-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine