Provider Demographics
NPI:1841564614
Name:SPELLER, DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SPELLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S CHESTNUT PL
Mailing Address - Street 2:UNIT 5102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-8143
Mailing Address - Country:US
Mailing Address - Phone:562-212-6536
Mailing Address - Fax:
Practice Address - Street 1:250 W OCEAN BLVD
Practice Address - Street 2:1703
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7939
Practice Address - Country:US
Practice Address - Phone:562-212-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant