Individual
MR. DANIEL JOSEPH MIZWICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1085 VALENCIA ST, SAN FRANCISCO, CA 94110-2405
(415) 432-7889
(415) 432-2701
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58421
CA
Other
Enumeration date
08/29/2013
Last updated
10/30/2020
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