Provider Demographics
NPI: | 1922049279 |
---|---|
Name: | URIBE, DANIEL (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DANIEL |
Middle Name: | |
Last Name: | URIBE |
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: | 121 N EUCLID ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LA HABRA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90631-4614 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 562-691-0811 |
Mailing Address - Fax: | 562-691-7013 |
Practice Address - Street 1: | 121 N EUCLID ST |
Practice Address - Street 2: | |
Practice Address - City: | LA HABRA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90631-4614 |
Practice Address - Country: | US |
Practice Address - Phone: | 562-691-0811 |
Practice Address - Fax: | 562-691-7013 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-09 |
Last Update Date: | 2008-12-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A42095 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00A420951 | Medicaid | |
CA | 00A420950 | Medicaid | |
CA | WA42095A | Medicare PIN | |
CA | WA42095B | Medicare ID - Type Unspecified | MEDICARE RENDERING NUMBER |
CA | 00A420950 | Medicaid | |
CA | E01652 | Medicare UPIN | |
CA | 00A420951 | Medicaid |