Healthcare Provider Details

I. General information

NPI: 1144379702
Provider Name (Legal Business Name): DARLENE MARIE EUBANKS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1032
US

IV. Provider business mailing address

1524 ACACIA APT 1
ALHAMBRA CA
91801-3111
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-7876
  • Fax: 323-851-7870
Mailing address:
  • Phone: 323-304-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: