Provider Demographics
NPI:1063848828
Name:DARDEN, XANIA (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:XANIA
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:NECIE
Other - Middle Name:
Other - Last Name:DARDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COSMETOLOGIST
Mailing Address - Street 1:4 AVENTINE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4296
Mailing Address - Country:US
Mailing Address - Phone:949-215-0994
Mailing Address - Fax:
Practice Address - Street 1:23331 EL TORO RD
Practice Address - Street 2:SUITE 114
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4891
Practice Address - Country:US
Practice Address - Phone:949-215-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB87443207N00000X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No207N00000XAllopathic & Osteopathic PhysiciansDermatology