Provider Demographics
NPI:1508831280
Name:MARNELL, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:MARNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6367 ALVARADO CT
Mailing Address - Street 2:SUITE107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4904
Mailing Address - Country:US
Mailing Address - Phone:619-287-1882
Mailing Address - Fax:619-287-4121
Practice Address - Street 1:6367 ALVARADO CT
Practice Address - Street 2:SUITE107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4904
Practice Address - Country:US
Practice Address - Phone:619-287-1882
Practice Address - Fax:619-287-4121
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33369207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC333691Medicaid
CAOOC333691Medicaid
CAA35242Medicare UPIN