Provider Demographics
NPI:1962407692
Name:SCIARONI, DANIEL M (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:SCIARONI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14741 CUMPSTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3730
Mailing Address - Country:US
Mailing Address - Phone:808-285-8734
Mailing Address - Fax:
Practice Address - Street 1:9726 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2717
Practice Address - Country:US
Practice Address - Phone:310-202-1300
Practice Address - Fax:310-202-1900
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-924207Q00000X
CA20A2439207QA0401X
CA20A 7439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50578701Medicaid
CAH58420Medicare UPIN
HI50578701Medicaid
HIH54210Medicare PIN
CAH54210Medicare PIN