Provider Demographics
NPI:1669555637
Name:MCBRIDE, DANIEL KELLEY (PAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KELLEY
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:EARL
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-341-2360
Mailing Address - Fax:760-346-5940
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:STE 202
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-341-2360
Practice Address - Fax:760-346-5940
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant