Healthcare Provider Details

I. General information

NPI: 1558410332
Provider Name (Legal Business Name): DARLA JEAN MCCOOL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 LAUREL PARK CIR
RIVERSIDE CA
92509-4096
US

IV. Provider business mailing address

21777 OSPREY LN
MORENO VALLEY CA
92557-8502
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-1816
  • Fax:
Mailing address:
  • Phone: 951-784-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN170819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: