Organization
DARYL P BANTA M.D., INC.
Active
Organization
DARYL P BANTA M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARYL P BANTA M.D., (DOCTOR)
(626) 486-0181
Entity
Organization
Contact information
Practice address
39 CONGRESS ST STE 201A, PASADENA, CA 91105-3021
(626) 486-0181
(626) 486-0189
Mailing address
PO BOX 50148, PASADENA, CA 91115-0148
(626) 486-0181
(626) 486-0189
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH151A
MEDICARE NUMBER
CA
Enumeration date
07/09/2010
Last updated
08/09/2011
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