Provider Demographics
NPI:1982880845
Name:DANIEL URIBE MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL URIBE MD A PROFESSIONAL CORPORATION
Other - Org Name:SAN MARCOS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-807-1877
Mailing Address - Street 1:13307 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2970
Mailing Address - Country:US
Mailing Address - Phone:562-807-1877
Mailing Address - Fax:562-868-6795
Practice Address - Street 1:13307 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2970
Practice Address - Country:US
Practice Address - Phone:562-807-1877
Practice Address - Fax:562-868-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420950Medicaid
CAW12103AMedicare PIN
CA00A420950Medicaid