Healthcare Provider Details

I. General information

NPI: 1013469402
Provider Name (Legal Business Name): ALMARTINO DARGAN II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 BIG BEND DR
DAYTON OH
45417-8816
US

IV. Provider business mailing address

5231 BIG BEND DR
DAYTON OH
45417-8816
US

V. Phone/Fax

Practice location:
  • Phone: 937-380-2737
  • Fax:
Mailing address:
  • Phone: 937-380-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTU702342
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberTU702342
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: