Provider Demographics
NPI:1538140017
Name:ZOVICH, DANIEL C (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:ZOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-1187
Mailing Address - Country:US
Mailing Address - Phone:805-476-6410
Mailing Address - Fax:805-476-6320
Practice Address - Street 1:1551 BISHOP ST # D450
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-476-6410
Practice Address - Fax:805-476-6320
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78252174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A78250Medicaid
CA00A78250Medicaid
CAWA78252BMedicare PIN
CA00A78250Medicaid