Healthcare Provider Details

I. General information

NPI: 1063693968
Provider Name (Legal Business Name): DAROLYN UNDERWOOD PLANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAROLYN SUE UNDERWOOD NP

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23228 MADERO
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

405 W 5TH ST STE 212
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 949-454-3940
  • Fax:
Mailing address:
  • Phone: 714-834-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP17831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: