Provider Demographics
NPI:1396863247
Name:VERMILION, DANIEL G
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:VERMILION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 90TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1879
Mailing Address - Country:US
Mailing Address - Phone:650-301-8670
Mailing Address - Fax:650-301-8639
Practice Address - Street 1:350 90TH ST FL 2
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1879
Practice Address - Country:US
Practice Address - Phone:650-301-8670
Practice Address - Fax:650-301-8639
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG488172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry