Provider Demographics
NPI:1043667488
Name:DANIEL, MATTHEW (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 MAGNOLIA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2355
Mailing Address - Country:US
Mailing Address - Phone:818-452-9902
Mailing Address - Fax:
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2355
Practice Address - Country:US
Practice Address - Phone:818-452-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5516213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program