Provider Demographics
NPI:1194276022
Name:NIGO, DARREN (ATC)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:NIGO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 E BARHAM DR
Mailing Address - Street 2:APT 233
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4470
Mailing Address - Country:US
Mailing Address - Phone:971-645-1300
Mailing Address - Fax:
Practice Address - Street 1:558 E BARHAM DR
Practice Address - Street 2:APT 233
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4470
Practice Address - Country:US
Practice Address - Phone:971-645-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20000220592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer