Provider Demographics
NPI:1184782666
Name:DINABURG, DANIEL CARL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CARL
Last Name:DINABURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:CARL
Other - Last Name:DINABURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:651 BELVEDERE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4313
Mailing Address - Country:US
Mailing Address - Phone:415-665-6669
Mailing Address - Fax:415-379-4541
Practice Address - Street 1:651 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4313
Practice Address - Country:US
Practice Address - Phone:415-665-6669
Practice Address - Fax:415-379-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2033802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G203380Medicaid
A40903Medicare UPIN
00G203380Medicare ID - Type Unspecified