Provider Demographics
NPI:1255560025
Name:NORED, DANIEL (IDMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NORED
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 S ALAMO AVE
Mailing Address - Street 2:
Mailing Address - City:DM AFB
Mailing Address - State:AZ
Mailing Address - Zip Code:85707-4402
Mailing Address - Country:US
Mailing Address - Phone:520-228-2721
Mailing Address - Fax:520-228-1549
Practice Address - Street 1:4175 S ALAMO AVE
Practice Address - Street 2:
Practice Address - City:DM AFB
Practice Address - State:AZ
Practice Address - Zip Code:85707-4402
Practice Address - Country:US
Practice Address - Phone:520-228-2721
Practice Address - Fax:520-228-1549
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians