Healthcare Provider Details

I. General information

NPI: 1659694073
Provider Name (Legal Business Name): DANIEL JONATHAN LANZARIN IV CADC-CAS C031100215
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 QUARRY RD FL 3
SAN CARLOS CA
94070-6221
US

IV. Provider business mailing address

550 QUARRY RD 3RD FLOOR
SAN CARLOS CA
94070
US

V. Phone/Fax

Practice location:
  • Phone: 650-421-3502
  • Fax: 650-598-2860
Mailing address:
  • Phone: 650-508-6745
  • Fax: 650-599-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC031100215
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number122789
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberC031100215
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberC031100215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: