Provider Demographics
NPI:1659694073
Name:LANZARIN, DANIEL JONATHAN IV (CADC-CAS C031100215)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JONATHAN
Last Name:LANZARIN
Suffix:IV
Gender:M
Credentials:CADC-CAS C031100215
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Mailing Address - Street 1:550 QUARRY RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-508-6745
Mailing Address - Fax:650-599-9273
Practice Address - Street 1:550 QUARRY RD FL 3
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-6221
Practice Address - Country:US
Practice Address - Phone:650-421-3502
Practice Address - Fax:650-598-2860
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2023-05-30
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Provider Licenses
StateLicense IDTaxonomies
CAC031100215101YA0400X, 171M00000X
CA122789101YA0400X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC031100215OtherCALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS - CCAPP