1043429186 NPI number — DARYL JAMES WILKINS D.O.

Table of content: DARYL JAMES WILKINS D.O. (NPI 1043429186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043429186 NPI number — DARYL JAMES WILKINS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINS
Provider First Name:
DARYL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043429186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDEN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95236-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-887-3891
Provider Business Mailing Address Fax Number:
209-887-2517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 BONHAM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDEN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95236-9491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-887-3891
Provider Business Practice Location Address Fax Number:
209-887-2517
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  20A 6047 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00AX60470 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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