Provider Demographics
NPI:1629180708
Name:AMOS, DANIEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5027
Mailing Address - Country:US
Mailing Address - Phone:213-353-0610
Mailing Address - Fax:213-353-4802
Practice Address - Street 1:1626 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5027
Practice Address - Country:US
Practice Address - Phone:213-353-0610
Practice Address - Fax:213-353-4802
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00085907OtherRAILROAD MEDICARE
CAWPA16740CMedicare ID - Type Unspecified
CAWPA16740AMedicare ID - Type Unspecified
Q05648Medicare UPIN
CAP00085907OtherRAILROAD MEDICARE
CAWPA16740DMedicare ID - Type Unspecified