Healthcare Provider Details

I. General information

NPI: 1750246468
Provider Name (Legal Business Name): MR. DAVID J SPANGLE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BARNEY RD
ANDERSON CA
96007-4301
US

IV. Provider business mailing address

2010 PONDEROSA ST APT 8
ANDERSON CA
96007-4363
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone: 916-642-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: