Provider Demographics
NPI:1083102503
Name:NESBITT, DARNELL M (RDMS, RVT)
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:M
Last Name:NESBITT
Suffix:
Gender:F
Credentials:RDMS, RVT
Other - Prefix:
Other - First Name:FRONTLINE ULTRASOUND
Other - Middle Name:ULTRASOUND
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDMS, RVT
Mailing Address - Street 1:1720 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5317
Mailing Address - Country:US
Mailing Address - Phone:510-816-0741
Mailing Address - Fax:
Practice Address - Street 1:1720 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5317
Practice Address - Country:US
Practice Address - Phone:510-816-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1308062471S1302X, 2471V0105X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography