Provider Demographics
NPI:1215793062
Name:DANGERFIELD, OCTAVIOUS MONIQUE
Entity type:Individual
Prefix:
First Name:OCTAVIOUS
Middle Name:MONIQUE
Last Name:DANGERFIELD
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 1:3633 PENDLETON CT
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2590
Mailing Address - Country:US
Mailing Address - Phone:214-815-5672
Mailing Address - Fax:
Practice Address - Street 1:3633 PENDLETON CT
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-2590
Practice Address - Country:US
Practice Address - Phone:214-815-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172A00000XOther Service ProvidersDriver
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle