Provider Demographics
NPI:1518071745
Name:ALTCHULER, DANIEL L (D P M)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:ALTCHULER
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 15TH ST STE 707
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1142
Mailing Address - Country:US
Mailing Address - Phone:310-451-8045
Mailing Address - Fax:310-451-8139
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 707
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1145
Practice Address - Country:US
Practice Address - Phone:310-451-8045
Practice Address - Fax:310-451-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE01822A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11063Medicare UPIN
4733990001Medicare NSC
CAWE1822BMedicare PIN