Basic Information
| Provider Information | |||||||||
| NPI: | 1164416939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE HAAS | ||||||||
| FirstName: | DARRYL | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E. WALNUT STREET | ||||||||
| Address2: | 3RD FLOOR PHR SYSTEMS | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264056768 | ||||||||
| FaxNumber: | 6264053640 | ||||||||
| Practice Location | |||||||||
| Address1: | 5601 DE SOTO AVENUE | ||||||||
| Address2: | KAISER, WOODLAND HILLS MEDICAL CENT | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913676701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187192000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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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 | 363A00000X | PA11598 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.