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General NPI Number Information
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NPI Number | 1245030543
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Entity Type | Individual
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Provider Name | JARED DONTOGAN
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Gender | Male
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 235 E DORSET DR
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City | DIXON
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State | CA
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Zip | 95620-9232
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Country | US
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Telephone | 707-693-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 2361 CAMPBELL CIR
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City | FAIRFIELD
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State | CA
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Zip | 94533-8928
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Country | US
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Telephone | 707-419-9756
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 90570
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License Number State | CA
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