Provider Demographics
NPI:1730173451
Name:PREOCANIN, DANIEL (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:PREOCANIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 HAYES ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1179
Mailing Address - Country:US
Mailing Address - Phone:415-240-4616
Mailing Address - Fax:415-240-4616
Practice Address - Street 1:2085 HAYES ST APT 11
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1179
Practice Address - Country:US
Practice Address - Phone:415-240-4616
Practice Address - Fax:415-240-4616
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623412Medicaid
NY02623412Medicaid
NYRA5923Medicare ID - Type Unspecified