Provider Demographics
NPI:1831118140
Name:PEARLSTEIN, DARYL P (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:P
Last Name:PEARLSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26039
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-6039
Mailing Address - Country:US
Mailing Address - Phone:714-263-9106
Mailing Address - Fax:949-650-1274
Practice Address - Street 1:1 HOAG DRIVE
Practice Address - Street 2:CANCER CENTER
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-650-3350
Practice Address - Fax:949-650-1274
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49447-020208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1831118140Medicaid
P00327489OtherRR MEDICARE
WI0002 68-086Medicare PIN
WI1831118140Medicaid
WI73-601 0005Medicare PIN
WI000301496Medicare PIN
WI000368249Medicare PIN