Provider Demographics
NPI:1376888735
Name:MCCONNELL, DANIEL BRIAN JR (MSPA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRIAN
Last Name:MCCONNELL
Suffix:JR
Gender:M
Credentials:MSPA
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Mailing Address - Street 1:1040 BERNARD DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1909
Mailing Address - Country:US
Mailing Address - Phone:714-595-4110
Mailing Address - Fax:
Practice Address - Street 1:101 LAGUNA RD
Practice Address - Street 2:SUITE A
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3634
Practice Address - Country:US
Practice Address - Phone:714-879-0050
Practice Address - Fax:714-879-0249
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22731363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical