Provider Demographics
NPI:1184729352
Name:EHRENSAFT, DANIEL VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VICTOR
Last Name:EHRENSAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3699
Mailing Address - Country:US
Mailing Address - Phone:310-202-9145
Mailing Address - Fax:310-202-0188
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-202-9145
Practice Address - Fax:310-202-0188
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22676207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G226760Medicaid
A41667Medicare UPIN
G22676Medicare ID - Type Unspecified