Provider Demographics
NPI:1770658270
Name:HYSLOP, DANIEL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARK
Last Name:HYSLOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 LMU DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2623
Mailing Address - Country:US
Mailing Address - Phone:310-338-2882
Mailing Address - Fax:310-338-4417
Practice Address - Street 1:1 LMU DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2623
Practice Address - Country:US
Practice Address - Phone:310-338-2882
Practice Address - Fax:310-338-4417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine