Basic Information
| Provider Information | |||||||||
| NPI: | 1194133041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ITANO | ||||||||
| FirstName: | DANIEL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5870 HIATUS RD | ||||||||
| Address2: | |||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333216424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884472362 | ||||||||
| FaxNumber: | 8655607110 | ||||||||
| Practice Location | |||||||||
| Address1: | 10301 JEFFREYS ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884472362 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A13692 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 008447 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO2126 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.