Provider Demographics
NPI:1447934468
Name:BANDEIRA, DARLAN LIMA ((OWNER))
Entity type:Individual
Prefix:
First Name:DARLAN
Middle Name:LIMA
Last Name:BANDEIRA
Suffix:
Gender:M
Credentials:(OWNER)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7583 ASPENPARK RD
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4507
Mailing Address - Country:US
Mailing Address - Phone:443-942-3284
Mailing Address - Fax:
Practice Address - Street 1:7583 ASPENPARK RD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4507
Practice Address - Country:US
Practice Address - Phone:443-942-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1470343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)