Healthcare Provider Details

I. General information

NPI: 1194216549
Provider Name (Legal Business Name): DARRIN WHEATON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41945 BIG BEAR BLVD SUITE, 221
BIG BEAR LAKE CA
92315-1927
US

IV. Provider business mailing address

PO BOX 1927
BIG BEAR LAKE CA
92315-1927
US

V. Phone/Fax

Practice location:
  • Phone: 909-866-5070
  • Fax: 909-878-3228
Mailing address:
  • Phone: 909-866-5070
  • Fax: 909-878-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: