Provider Demographics
NPI:1497971790
Name:DEUGARTE, DANIEL ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALBERTO
Last Name:DEUGARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-206-2429
Mailing Address - Fax:310-206-1120
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:SUITE 526
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-206-2429
Practice Address - Fax:310-206-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA703002086S0120X
MI4301084844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703000Medicaid
CA00A703000Medicaid