Provider Demographics
NPI:1134399884
Name:JOHN, DANIEL (NBC HIS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:NBC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3300
Mailing Address - Country:US
Mailing Address - Phone:505-890-1559
Mailing Address - Fax:
Practice Address - Street 1:10090 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3300
Practice Address - Country:US
Practice Address - Phone:505-890-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM699237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist