Provider Demographics
NPI:1912743626
Name:DARQUEA, NOELLE CAROLINE
Entity type:Individual
Prefix:MISS
First Name:NOELLE
Middle Name:CAROLINE
Last Name:DARQUEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 BASILONE ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5417
Mailing Address - Country:US
Mailing Address - Phone:619-376-8908
Mailing Address - Fax:
Practice Address - Street 1:3884 BASILONE ST UNIT 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5417
Practice Address - Country:US
Practice Address - Phone:619-376-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer