Provider Demographics
NPI:1255629846
Name:DYTIAPCO, ERNEST DANIEL MORENO (MD)
Entity type:Individual
Prefix:MR
First Name:ERNEST DANIEL
Middle Name:MORENO
Last Name:DYTIAPCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9161 SEVILLE LN
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:986-200-8202
Mailing Address - Fax:626-593-4751
Practice Address - Street 1:1551 BISHOP ST STE 110
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:208-422-1314
Practice Address - Fax:208-422-1536
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-12535207RN0300X
IDMRM-1270207R00000X
CAA136945207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine