Provider Demographics
NPI:1144812355
Name:DARMAWAN, NATHALIE R
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:R
Last Name:DARMAWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 SNOWCREEK ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5074
Mailing Address - Country:US
Mailing Address - Phone:805-416-4833
Mailing Address - Fax:
Practice Address - Street 1:5319 SNOWCREEK ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5074
Practice Address - Country:US
Practice Address - Phone:805-416-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician