Healthcare Provider Details

I. General information

NPI: 1215351663
Provider Name (Legal Business Name): DARRYL KENNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13204 DAY ST APT L203
MORENO VALLEY CA
92553-7392
US

IV. Provider business mailing address

13204 DAY ST APT L203
MORENO VALLEY CA
92553-7392
US

V. Phone/Fax

Practice location:
  • Phone: 951-999-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRRW5114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: