Provider Demographics
NPI:1023161619
Name:MCDANIEL, ANNE-MARIE EDITH (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:EDITH
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 S GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4163
Mailing Address - Country:US
Mailing Address - Phone:831-722-2422
Mailing Address - Fax:831-722-2855
Practice Address - Street 1:1066 S. GREEN VALLEY RD.
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-722-2422
Practice Address - Fax:831-722-2855
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87091OtherCA MEDICAL LISENSE NO
CAI27313Medicare UPIN