Provider Demographics
NPI:1578608394
Name:MARCEL F DANIELS MD FACS FICS MED CORP
Entity Type:Organization
Organization Name:MARCEL F DANIELS MD FACS FICS MED CORP
Other - Org Name:IMAGE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-597-4575
Mailing Address - Street 1:1760 TERMINO AVE. STE. 207
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-597-4575
Mailing Address - Fax:562-597-4509
Practice Address - Street 1:1760 TERMINO AVE. STE. 207
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-597-4575
Practice Address - Fax:562-597-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE95997Medicare UPIN
CAW20740Medicare PIN