Provider Demographics
NPI:1235315391
Name:DANIEL URIBE MD
Entity Type:Organization
Organization Name:DANIEL URIBE MD
Other - Org Name:SAN MARCOS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-691-0811
Mailing Address - Street 1:121 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4614
Mailing Address - Country:US
Mailing Address - Phone:562-691-0811
Mailing Address - Fax:562-690-7013
Practice Address - Street 1:121 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-4614
Practice Address - Country:US
Practice Address - Phone:562-691-0811
Practice Address - Fax:562-690-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420951Medicaid
CAE01652Medicare UPIN
CA00A420951Medicaid