Healthcare Provider Details

I. General information

NPI: 1013557875
Provider Name (Legal Business Name): DARIAN DENE MINZENMAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 INDIAN RIVER BLVD
VERO BEACH FL
32960-5639
US

IV. Provider business mailing address

1555 INDIAN RIVER BLVD
VERO BEACH FL
32960-5639
US

V. Phone/Fax

Practice location:
  • Phone: 772-778-1323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number1184124
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: