Provider Demographics
NPI:1053164343
Name:PURCELL, DAJUAN
Entity type:Individual
Prefix:
First Name:DAJUAN
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 EAST CARNIEGE DR. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:760-237-8070
Mailing Address - Fax:
Practice Address - Street 1:473 EAST CARNIEGE DR. SUITE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:760-237-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician