Provider Demographics
NPI:1063489532
Name:DANIELS, ROBERT A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:DANIELS
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 1:1398 LOS OSOS VALLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3342
Mailing Address - Country:US
Mailing Address - Phone:805-528-7643
Mailing Address - Fax:805-528-0232
Practice Address - Street 1:1398 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3342
Practice Address - Country:US
Practice Address - Phone:805-528-7643
Practice Address - Fax:805-528-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2012-09-05
Deactivation Date:2006-03-07
Deactivation Code:
Reactivation Date:2006-03-13
Provider Licenses
StateLicense IDTaxonomies
CAE2039213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E20390Medicaid
CA00E20391Medicaid
E2039Medicare PIN
480026093Medicare PIN
T11148Medicare UPIN
CA00E20391Medicaid