Provider Demographics
NPI:1295834091
Name:DANIEL C ZOVICH MD INC
Entity type:Organization
Organization Name:DANIEL C ZOVICH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-476-6410
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-1187
Mailing Address - Country:US
Mailing Address - Phone:805-476-6410
Mailing Address - Fax:805-476-6320
Practice Address - Street 1:1551 BISHOP ST STE 450
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4663
Practice Address - Country:US
Practice Address - Phone:805-476-6410
Practice Address - Fax:805-476-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A78252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA78252BOtherPPIN
CA00A782520Medicaid
CAW17371Medicare ID - Type Unspecified
CAH71588Medicare UPIN