Healthcare Provider Details

I. General information

NPI: 1902967987
Provider Name (Legal Business Name): DARRELL BRIAN DINSMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVENUE
CHICO CA
95926
US

IV. Provider business mailing address

107 W 16TH ST #4
CHICO CA
95928
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax: 530-895-6547
Mailing address:
  • Phone: 530-571-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: