Healthcare Provider Details

I. General information

NPI: 1740378975
Provider Name (Legal Business Name): DANIEL WAYNE MANSFIELD CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 FLORIN RD
SACRAMENTO CA
95823-2535
US

IV. Provider business mailing address

730 SUNRISE AVE STE 250
ROSEVILLE CA
95661-4556
US

V. Phone/Fax

Practice location:
  • Phone: 916-349-2320
  • Fax:
Mailing address:
  • Phone: 916-787-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA8472105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: