Provider Demographics
NPI:1760665624
Name:DANIEL L ENGEBERG, MD, INC.
Entity Type:Organization
Organization Name:DANIEL L ENGEBERG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENGEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:M,D,
Authorized Official - Phone:559-585-8755
Mailing Address - Street 1:PO BOX 1661
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1661
Mailing Address - Country:US
Mailing Address - Phone:559-585-8755
Mailing Address - Fax:559-585-8440
Practice Address - Street 1:1105 N DOUTY ST
Practice Address - Street 2:SUITE A
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3716
Practice Address - Country:US
Practice Address - Phone:559-585-8755
Practice Address - Fax:559-585-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51460Medicare UPIN