Provider Demographics
NPI:1508964628
Name:MCGINN, DANIEL T (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:MCGINN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PARK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7385
Mailing Address - Country:US
Mailing Address - Phone:805-907-8256
Mailing Address - Fax:
Practice Address - Street 1:124 PARK HILL RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7385
Practice Address - Country:US
Practice Address - Phone:805-907-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1078207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV036103020Medicaid
NV599430Medicare ID - Type Unspecified
NV036103020Medicaid