Individual
DARYL JOHN KALLENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNA
Contact information
Practice address
3465 THUNDERBIRD LN, LAKE HAVASU CITY, AZ 86406-5556
(928) 706-5851
Mailing address
1345 BEEFEATER DR, LAKE HAVASU CITY, AZ 86404-1953
(928) 706-5851
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
CNA1000021924
AZ
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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