Healthcare Provider Details

I. General information

NPI: 1639472236
Provider Name (Legal Business Name): DERRICK DEWAYNE SWEAT IDMT- PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S DAKOTA AVE
LOMPOC CA
93437-6307
US

IV. Provider business mailing address

1711 D STREET
FT WORTH TX
76127
US

V. Phone/Fax

Practice location:
  • Phone: 228-313-3342
  • Fax:
Mailing address:
  • Phone: 817-782-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: