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General NPI Number Information
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NPI Number | 1770725145
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Entity Type | Organization
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Legal Business Name | DARRYL WILLOUGHBY M.D., INC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 1414 S GRAND AVE SUITE 307
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City | LOS ANGELES
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State | CA
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Zip | 90015-3067
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Country | US
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Telephone | 213-765-8088
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Fax | 310-329-3239
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Provider Business Mailing Address
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Address Line | PO BOX 6620
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City | TORRANCE
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State | CA
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Zip | 90504-0620
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Country | US
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Telephone | 310-968-6012
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Fax | 310-329-3239
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DARRYL A WILLOUGHBY
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Credential | MD
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Telephone | 310-968-6012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A54030
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License Number State | CA
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