Basic Information
| Provider Information | |||||||||
| NPI: | 1043856917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALISAY | ||||||||
| FirstName: | DARREN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12849 SHADY OAK CT | ||||||||
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| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920646053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199132048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4435 EASTGATE MALL STE 120 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921211980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585878669 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2019 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA48136 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.