Provider Demographics
NPI:1669251393
Name:RANDOLPH, DARNELL HOUSTON
Entity type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:HOUSTON
Last Name:RANDOLPH
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 1:24330 NARBONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1131
Mailing Address - Country:US
Mailing Address - Phone:310-534-6206
Mailing Address - Fax:
Practice Address - Street 1:24330 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1131
Practice Address - Country:US
Practice Address - Phone:310-534-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator