Individual
DARYL TADASHI KUBOTSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7117 BROCKTON AVE, RIVERSIDE, CA 92506-2615
(951) 782-3853
(951) 784-3269
Mailing address
3660 ARLINGTON AVE, RIVERSIDE, CA 92506-3912
(951) 782-3853
(951) 784-3269
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730180415
GROUP NPI#
—
01
—
ZZZ318872
GROUP SITE #
—
Enumeration date
11/23/2005
Last updated
05/09/2008
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