Basic Information
| Provider Information | |||||||||
| NPI: | 1730133372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALAC | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 AMETHYST WAY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920291608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50100 GOLSH RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CENTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920825338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A73561 | CA | X | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | A73561 | CA | X | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000A73561 | 05 | CA | MEDICAID |