Healthcare Provider Details

I. General information

NPI: 1912952276
Provider Name (Legal Business Name): DARRELL CORBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 DEGUIGNE DR #1
SUNNYVALE CA
94085-3875
US

IV. Provider business mailing address

PO BOX 464
MOUNTAIN VIEW CA
94042-0464
US

V. Phone/Fax

Practice location:
  • Phone: 877-845-8959
  • Fax: 877-845-8959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA052058
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA052058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: