MEDICARE: MS. DARCINA ANN STARK ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1346260478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARCINA ANN STARK ATC

Provider Business Mailing Address
First Line	:	570 E CREEKSIDE CIR
Second Line	:
City	:	DIXON
State	:	CA
Zip	:	95620-3157
Country	:	US
Telephone Number	:	916-709-9395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-2727
Country	:	US
Telephone Number	:	916-733-3671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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