Provider Demographics
NPI:1538851613
Name:STRADER, DARMISHA
Entity type:Individual
Prefix:
First Name:DARMISHA
Middle Name:
Last Name:STRADER
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 1:23474 SILVER STRIKE DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7416
Mailing Address - Country:US
Mailing Address - Phone:858-789-8686
Mailing Address - Fax:
Practice Address - Street 1:23474 SILVER STRIKE DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7416
Practice Address - Country:US
Practice Address - Phone:858-789-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician