Provider Demographics
NPI:1982050936
Name:MCDANIEL, MARY FRANCES (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1608 PACIFIC AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5112
Mailing Address - Country:US
Mailing Address - Phone:310-392-6462
Mailing Address - Fax:310-392-6693
Practice Address - Street 1:1608 PACIFIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-5112
Practice Address - Country:US
Practice Address - Phone:310-392-6462
Practice Address - Fax:310-392-6693
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A 58382083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine