Provider Demographics
NPI:1225265481
Name:BEBEREIA, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:BEBEREIA
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 1:22 RUNNING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5221
Mailing Address - Country:US
Mailing Address - Phone:949-293-9304
Mailing Address - Fax:
Practice Address - Street 1:8893 LA MESA BLVD
Practice Address - Street 2:STE D
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5448
Practice Address - Country:US
Practice Address - Phone:619-460-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA115593207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program