Healthcare Provider Details

I. General information

NPI: 1285208579
Provider Name (Legal Business Name): MARIE NATHALIE CLARA DARGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date: 06/15/2021
Reactivation Date: 06/30/2021

III. Provider practice location address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-445-3338
  • Fax:
Mailing address:
  • Phone: 951-358-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52196
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number52196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: