Provider Demographics
NPI:1659830602
Name:DARE, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:DARE
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 1:255 W 5TH ST APT 219
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3390
Mailing Address - Country:US
Mailing Address - Phone:310-774-7584
Mailing Address - Fax:
Practice Address - Street 1:255 W 5TH ST APT 219
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3390
Practice Address - Country:US
Practice Address - Phone:310-774-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)