Healthcare Provider Details

I. General information

NPI: 1790719482
Provider Name (Legal Business Name): GLENN D D'ARPA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 AUSTIN DR STE 101
SPRING VALLEY CA
91978-1521
US

IV. Provider business mailing address

10225 AUSTIN DR STE 101
SPRING VALLEY CA
91978-1521
US

V. Phone/Fax

Practice location:
  • Phone: 616-660-6003
  • Fax: 619-660-0296
Mailing address:
  • Phone: 616-660-6003
  • Fax: 619-660-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: