Provider Demographics
NPI:1659721249
Name:SACDALAN, DARWIN
Entity Type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:
Last Name:SACDALAN
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 1:7137 LYNDALE CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6357
Mailing Address - Country:US
Mailing Address - Phone:909-565-3672
Mailing Address - Fax:
Practice Address - Street 1:7137 LYNDALE CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6357
Practice Address - Country:US
Practice Address - Phone:909-565-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727610364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13994192OtherKAISER PERMANENTE