Basic Information
| Provider Information | |||||||||
| NPI: | 1629339593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORMAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| OtherLastName: | CORMAN | ||||||||
| OtherFirstName: | DAN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6699 ALVARADO ROAD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314196841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5454 EL CAJON BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921153621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195152400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 20A13060 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.