Provider Demographics
NPI:1316243413
Name:EMPALMADO, DARRYL JOHN (PTA)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:JOHN
Last Name:EMPALMADO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 LOTUS ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0779
Mailing Address - Country:US
Mailing Address - Phone:714-716-6744
Mailing Address - Fax:
Practice Address - Street 1:6545 LOTUS ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-0779
Practice Address - Country:US
Practice Address - Phone:714-716-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6843225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant