Provider Demographics
NPI:1235127564
Name:WALIGORA, DANIEL PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILIP
Last Name:WALIGORA
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 1:147 EL DORADO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3127
Mailing Address - Country:US
Mailing Address - Phone:831-373-1813
Mailing Address - Fax:831-373-1146
Practice Address - Street 1:147 EL DORADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3127
Practice Address - Country:US
Practice Address - Phone:831-373-1813
Practice Address - Fax:831-373-1146
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ69774YOtherBLUE SHIELD
CA00C255620Medicaid
CAZZZ69774YOtherBLUE SHIELD
CA00C255620Medicaid