Provider Demographics
NPI:1457024606
Name:NEAL, DYLAN T
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:T
Last Name:NEAL
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 1:8461 WHISPERING OAK LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-3867
Mailing Address - Country:US
Mailing Address - Phone:916-208-3277
Mailing Address - Fax:
Practice Address - Street 1:525 SOUTH DR STE 115
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4211
Practice Address - Country:US
Practice Address - Phone:650-969-5600
Practice Address - Fax:650-969-0360
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty