Provider Demographics
NPI:1104425347
Name:DARIUS, SOPHONI NDAHIYIMBAZE
Entity type:Individual
Prefix:
First Name:SOPHONI
Middle Name:NDAHIYIMBAZE
Last Name:DARIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6713
Mailing Address - Country:US
Mailing Address - Phone:319-573-9154
Mailing Address - Fax:
Practice Address - Street 1:1475 BLACKHAWK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-6713
Practice Address - Country:US
Practice Address - Phone:319-573-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)