Provider Demographics
NPI:1578144226
Name:DAMRON, DARTENION
Entity Type:Individual
Prefix:
First Name:DARTENION
Middle Name:
Last Name:DAMRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 SE 20TH RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1922
Mailing Address - Country:US
Mailing Address - Phone:661-965-1999
Mailing Address - Fax:
Practice Address - Street 1:1399 SE 20TH RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1922
Practice Address - Country:US
Practice Address - Phone:661-965-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician