Provider Demographics
NPI:1760459622
Name:LEPORE, DANIEL J (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:LEPORE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0734
Mailing Address - Country:US
Mailing Address - Phone:760-633-4700
Mailing Address - Fax:760-635-4350
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:STE A202
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-633-4700
Practice Address - Fax:760-635-4350
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16333207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16333BOtherPPIN
CAWPA16333BOtherPPIN
CAW18361Medicare ID - Type Unspecified