Provider Demographics
NPI:1073169769
Name:PATIAG, DANIEL BACTOL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BACTOL
Last Name:PATIAG
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:BACTOL
Other - Last Name:PATIAG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1320 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-8531
Mailing Address - Country:US
Mailing Address - Phone:619-456-9800
Mailing Address - Fax:
Practice Address - Street 1:1320 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8531
Practice Address - Country:US
Practice Address - Phone:619-456-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily