Healthcare Provider Details

I. General information

NPI: 1588051361
Provider Name (Legal Business Name): DARCY JAMES MAINVILLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11245 ANDERSON ST
LOMA LINDA CA
92354-2801
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4085
  • Fax:
Mailing address:
  • Phone: 909-558-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA144998
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA144998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: