Provider Demographics
NPI:1770584534
Name:FLANIGAN, DANIEL PRESTON (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PRESTON
Last Name:FLANIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4303
Mailing Address - Country:US
Mailing Address - Phone:714-560-4450
Mailing Address - Fax:714-560-4455
Practice Address - Street 1:1010 W LA VETA AVE STE 320
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4303
Practice Address - Country:US
Practice Address - Phone:714-560-4450
Practice Address - Fax:714-560-4455
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0635322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
050069CE38014OtherTRAILBLAZER
CA00G635320Medicaid
770003143OtherRAILROAD MEDICARE
00G635320OtherBLUE SHIELD OF CA
00G635320 M46OtherCALOPTIMA
00G635320OtherBLUE SHIELD OF CA
00G635320 M46OtherCALOPTIMA