Healthcare Provider Details

I. General information

NPI: 1992093876
Provider Name (Legal Business Name): BRIAN DARGIEWICZ RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S EL CAMINO REAL
SAN MATEO CA
94402-2804
US

IV. Provider business mailing address

1108 S EL CAMINO REAL
SAN MATEO CA
94402-2804
US

V. Phone/Fax

Practice location:
  • Phone: 650-458-0026
  • Fax: 650-458-0027
Mailing address:
  • Phone: 650-458-0026
  • Fax: 650-458-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035683
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number822984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: