Healthcare Provider Details

I. General information

NPI: 1114143435
Provider Name (Legal Business Name): MR. DARIN MATTHEW STANGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DRIVE SUITE B
VANCOUVER WA
98662
US

IV. Provider business mailing address

7616 NE 152ND AVE
VANCOUVER WA
98682-5121
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-449-0527
  • Fax: 360-449-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00056884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: