MEDICARE: DARREN R THOMPSON D.O.

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
1	208D00000X	General Practice Physician	5101018790	MI
2	208D00000X	General Practice Physician	20A13605	CA

General Provider Information

NPI Number	:	1942513734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN R THOMPSON D.O.

Provider Business Mailing Address
First Line	:	9818 CAMINO DEL CORONADO
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-3549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9818 CAMINO DEL CORONADO
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-3549
Country	:	US
Telephone Number	:	435-760-1529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	11/15/2019

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Directions to “ DARREN R THOMPSON D.O.” Practice Location

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