Healthcare Provider Details

I. General information

NPI: 1144272766
Provider Name (Legal Business Name): DARLENE M ANDROUS JUNK PA/C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 SOLANO STREET
CORNING CA
96021
US

IV. Provider business mailing address

2126 SOLANO STREET
CORNING CA
96021
US

V. Phone/Fax

Practice location:
  • Phone: 530-824-7845
  • Fax: 530-824-4084
Mailing address:
  • Phone: 530-824-7845
  • Fax: 530-824-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: