Healthcare Provider Details

I. General information

NPI: 1427420405
Provider Name (Legal Business Name): DARREL DYAS PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41250 12TH ST W STE C
PALMDALE CA
93551-1444
US

IV. Provider business mailing address

41250 12TH ST W STE C
PALMDALE CA
93551-1444
US

V. Phone/Fax

Practice location:
  • Phone: 855-522-3682
  • Fax: 323-268-6738
Mailing address:
  • Phone: 855-522-3682
  • Fax: 323-268-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000006936
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: