Provider Demographics
NPI:1255599015
Name:DANIELS, MATHIAS WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MATHIAS
Middle Name:WAYNE
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 NEILSON ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-763-6049
Mailing Address - Fax:831-768-6289
Practice Address - Street 1:65 NEILSON ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2491
Practice Address - Country:US
Practice Address - Phone:831-763-6049
Practice Address - Fax:831-768-6289
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60272416207XS0117X
CAA126857207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1255599015Medicaid
WA0294301OtherL&I
8909607Medicare PIN