Healthcare Provider Details

I. General information

NPI: 1760800411
Provider Name (Legal Business Name): MRS. DARLENE HARDIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DARLENE FRAUSTO

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD OP160
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD OP160
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2997
  • Fax:
Mailing address:
  • Phone: 916-734-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: