Provider Demographics
NPI:1902859093
Name:DICESARE, DANIEL ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDRES
Last Name:DICESARE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34145 PACIFIC COAST HWY
Mailing Address - Street 2:# 670
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2808
Mailing Address - Country:US
Mailing Address - Phone:949-888-8500
Mailing Address - Fax:949-888-9724
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 150
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3947
Practice Address - Country:US
Practice Address - Phone:949-888-8500
Practice Address - Fax:949-709-4111
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-03-06
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Provider Licenses
StateLicense IDTaxonomies
CAA83696207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL114ZMedicare PIN
CABL 114BMedicare PIN
CAH92660Medicare UPIN