Provider Demographics
NPI:1629857198
Name:DARBANDI, MATT
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:DARBANDI
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 1:22305 SAVONA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1853
Mailing Address - Country:US
Mailing Address - Phone:949-502-1364
Mailing Address - Fax:
Practice Address - Street 1:22305 SAVONA
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1853
Practice Address - Country:US
Practice Address - Phone:949-502-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306006337376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator