Provider Demographics
NPI:1942345947
Name:PLETSCH, DANIEL LESLIE (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LESLIE
Last Name:PLETSCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14075 HESPERIA RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4500
Mailing Address - Country:US
Mailing Address - Phone:760-955-6458
Mailing Address - Fax:760-955-6420
Practice Address - Street 1:14075 HESPERIA RD
Practice Address - Street 2:SUITE 207
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-955-6458
Practice Address - Fax:760-955-6420
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP06495Medicare UPIN