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NPI Code Detail

MEDICARE: MR. DARRYL DE HAAS PA-C

MEDICARE: MR. DARRYL DE HAAS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA11598CA

General Provider Information

NPI Number : 1164416939
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARRYL DE HAAS PA-C
Provider Business Mailing Address
First Line : 393 E. WALNUT STREET
Second Line : 3RD FLOOR PHR SYSTEMS
City : PASADENA
State : CA
Zip : 91188-0001
Country : US
Telephone Number : 626-405-6768
Fax Number : 626-405-3640
Provider Business Practice Location Address
First Line : 5601 DE SOTO AVENUE
Second Line : KAISER, WOODLAND HILLS MEDICAL CENT
City : WOODLAND HILLS
State : CA
Zip : 91367-6701
Country : US
Telephone Number : 818-719-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 09/25/2007

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