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General NPI Number Information
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NPI Number | 1013620939
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Entity Type | Individual
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Provider Name | PRIYANKA DAS
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Gender | Female
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 4704 BRANDING IRON DR
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City | FAIRFIELD
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State | CA
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Zip | 94534-7468
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Country | US
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Telephone | 714-930-3296
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Fax |
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Provider Business Mailing Address
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Address Line | 4704 BRANDING IRON DR
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City | FAIRFIELD
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State | CA
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Zip | 94534-7468
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Country | US
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Telephone | 714-930-3296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 95024376
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 95190498
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License Number State | CA
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