Fonder, Darek Ray

Fonder, Darek Ray is an individual health care provider with primary practice located at 2862 Canyon Springs Pkwy , Riverside CA 92507-0928. He recently has only one registered license in Dental Providers / Dental Assistant, which is considered as his primary health care specialty. Fonder, Darek Ray can be contacted via phone (310) 344-7632.

Contact Information

Primary practice address
2862 Canyon Springs Pkwy Riverside CA 92507-0928
Phone: (310) 344-7632
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Assistant 126800000X 93206 California

Profile Details

NPI number 1588275291
LBN Legal business name Fonder, Darek Ray
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2020
Last updated Aug 14th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588275291 NPPES
California MEDICAID 93206

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