Provider Demographics
NPI:1992761449
Name:DARIUS, MICHAEL R (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:DARIUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CREEKSIDE DR STE 1400
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3445
Mailing Address - Country:US
Mailing Address - Phone:916-984-8244
Mailing Address - Fax:
Practice Address - Street 1:329 W. 8TH ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4533
Practice Address - Country:US
Practice Address - Phone:559-587-4532
Practice Address - Fax:559-589-1867
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15354363AM0700X, 363A00000X
CAPA15354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP20360Medicare UPIN