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NPI Code Detail

MEDICARE: DR. DERRICK R DARNSTEADT MD

MEDICARE: DR. DERRICK R DARNSTEADT MD
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
1207P00000XEmergency Medicine PhysicianA92752CA
2207P00000XEmergency Medicine PhysicianMD.30306AL
3208D00000XGeneral Practice PhysicianA92752CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11497725758OTHERALTRICARE SOUTH
2Z10777OTHERALVIVA HEALTH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5511-09380OTHERALBCBS

General Provider Information

NPI Number : 1497725758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DERRICK R DARNSTEADT MD
Provider Business Mailing Address
First Line : 1825 WESTHOLME AVE APT 5
Second Line : EMERGENCY DEPARTMENT
City : LOS ANGELES
State : CA
Zip : 90025-4954
Country : US
Telephone Number : 310-801-8546
Fax Number :
Provider Business Practice Location Address
First Line : 11301 WILSHIRE BLVD
Second Line : EMERGENCY DEPARTMENT
City : LOS ANGELES
State : CA
Zip : 90073-1003
Country : US
Telephone Number : 310-268-3711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 04/26/2017

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Directions to “ DR. DERRICK R DARNSTEADT MD” Practice Location

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