1659694073 NPI number — MR. DANIEL JONATHAN LANZARIN IV CADC-CAS C031100215

Table of content: MR. DANIEL JONATHAN LANZARIN IV CADC-CAS C031100215 (NPI 1659694073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659694073 NPI number — MR. DANIEL JONATHAN LANZARIN IV CADC-CAS C031100215

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANZARIN
Provider First Name:
DANIEL
Provider Middle Name:
JONATHAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
CADC-CAS C031100215
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659694073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 QUARRY RD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
SAN CARLOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-508-6745
Provider Business Mailing Address Fax Number:
650-599-9273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 QUARRY RD FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94070-6221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-421-3502
Provider Business Practice Location Address Fax Number:
650-598-2860
Provider Enumeration Date:
03/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  C031100215 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 122789 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X , with the licence number: C031100215 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C031100215 . This is a "CALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS - CCAPP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".