Healthcare Provider Details

I. General information

NPI: 1518024108
Provider Name (Legal Business Name): DARRYL JONATHAN WERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 HERON CIRCLE
SEAL BEACH CA
90740
US

IV. Provider business mailing address

951 HERON CIRCLE
SEAL BEACH CA
90740
US

V. Phone/Fax

Practice location:
  • Phone: 949-351-8977
  • Fax: 562-430-6706
Mailing address:
  • Phone: 949-351-8977
  • Fax: 562-430-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG066730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberG66730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: