Provider Demographics
NPI:1902240179
Name:MCCARTHY, DANIEL PETER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PETER
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 TELEGRAPH CANYON RD
Mailing Address - Street 2:APT 572
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6436
Mailing Address - Country:US
Mailing Address - Phone:619-851-7762
Mailing Address - Fax:
Practice Address - Street 1:207 W LEGION RD
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7780
Practice Address - Country:US
Practice Address - Phone:760-351-3409
Practice Address - Fax:760-351-4546
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant