Provider Demographics
NPI:1457024606
Name:NEAL, DYLAN T
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:T
Last Name:NEAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 PLAZA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4427
Mailing Address - Country:US
Mailing Address - Phone:916-208-3277
Mailing Address - Fax:
Practice Address - Street 1:2203 PLAZA DR STE 110
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4427
Practice Address - Country:US
Practice Address - Phone:916-208-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty