Provider Demographics
NPI:1184379794
Name:NEEL, DAKOTA MATTHEW SOMMERS (SF IDC STUDENT)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:MATTHEW SOMMERS
Last Name:NEEL
Suffix:
Gender:M
Credentials:SF IDC STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 BROADWAY APT 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4921
Mailing Address - Country:US
Mailing Address - Phone:775-530-8256
Mailing Address - Fax:
Practice Address - Street 1:34101 FARENHOLT AVE # BDLG14
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-7000
Practice Address - Country:US
Practice Address - Phone:775-530-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program