Organization
CHARLES SHANE DANIELS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES SHANE DANIELS MD (PHYSICIAN OWNER)
(714) 456-3472
Entity
Organization
Contact information
Practice address
25652 OLD TRABUCO RD, LAKE FOREST, CA 92630-2776
(714) 456-3472
Mailing address
34145 PACIFIC COAST HWY, #603, DANA POINT, CA 92629-2808
(714) 456-3472
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A94985
CA
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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