Healthcare Provider Details

I. General information

NPI: 1245078294
Provider Name (Legal Business Name): DAVID GILBERT VERDIN ACSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

PO BOX 2499
FULLERTON CA
92837-0499
US

V. Phone/Fax

Practice location:
  • Phone: 657-339-2799
  • Fax:
Mailing address:
  • Phone: 714-726-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: