Provider Demographics
NPI:1033267166
Name:ANDERSON, DANIEL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DEAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3901 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6361
Mailing Address - Country:US
Mailing Address - Phone:619-807-7724
Mailing Address - Fax:619-367-0379
Practice Address - Street 1:380 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6641
Practice Address - Country:US
Practice Address - Phone:619-807-7224
Practice Address - Fax:310-367-0379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG644712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15753Medicare UPIN
CADL925AMedicare PIN
CAE66678Medicare UPIN
CAG64471Medicare ID - Type Unspecified