Provider Demographics
NPI:1720792237
Name:DANGERFIELD, DARLENE L
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:L
Last Name:DANGERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ALAMO DR APT 25
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6023
Mailing Address - Country:US
Mailing Address - Phone:707-720-6642
Mailing Address - Fax:
Practice Address - Street 1:1501 ALAMO DR APT 25
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6023
Practice Address - Country:US
Practice Address - Phone:707-720-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93914013A6OtherMEDI-CAL