Provider Demographics
NPI:1619218088
Name:REALINI, DANIEL JAMES (MPAS, PA--C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:REALINI
Suffix:
Gender:M
Credentials:MPAS, PA--C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PISANO HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7696
Mailing Address - Country:US
Mailing Address - Phone:415-770-9254
Mailing Address - Fax:
Practice Address - Street 1:1380 E FILLMORE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6460
Practice Address - Country:US
Practice Address - Phone:719-630-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant