Provider Demographics
NPI:1790906527
Name:DANIAL, GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:DANIAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 RUBIO AVENUE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3203
Mailing Address - Country:US
Mailing Address - Phone:818-981-0050
Mailing Address - Fax:818-907-7080
Practice Address - Street 1:4621 RUBIO AVENUE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3203
Practice Address - Country:US
Practice Address - Phone:818-981-0050
Practice Address - Fax:818-907-7080
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX47200Medicaid
CA00AX47200Medicaid