Provider Demographics
NPI:1053320556
Name:CEPIN, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CEPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 EASTLAKE PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4520
Mailing Address - Country:US
Mailing Address - Phone:619-482-0300
Mailing Address - Fax:619-482-0959
Practice Address - Street 1:890 EASTLAKE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4520
Practice Address - Country:US
Practice Address - Phone:619-482-0300
Practice Address - Fax:619-482-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52521207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G525210Medicaid
CA00G525210Medicaid
CAG52521Medicare ID - Type Unspecified