Provider Demographics
NPI:1003220989
Name:DESANTIS, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5000
Mailing Address - Country:US
Mailing Address - Phone:619-532-7400
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - Street 2:200 MERCY CIRCLE
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-716-4061
Practice Address - Fax:760-725-1303
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2025-01-31
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Provider Licenses
StateLicense IDTaxonomies
CAA139601207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN