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
StateLicense IDTaxonomies
CAA42095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420951Medicaid
CA00A420950Medicaid
CAWA42095AMedicare PIN
CAWA42095BMedicare ID - Type UnspecifiedMEDICARE RENDERING NUMBER
CA00A420950Medicaid
CAE01652Medicare UPIN
CA00A420951Medicaid