Individual
DARYL BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10 CONGRESS ST STE 155, PASADENA, CA 91105-3045
(626) 486-0181
(626) 486-0189
Mailing address
39 CONGRESS ST, SECOND FLOOR, PASADENA, CA 91105-3024
(626) 486-0181
(866) 765-3604
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A88722
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A88722
CA
207RP1001X
Pulmonary Disease Physician
A88722
CA
Other
Enumeration date
10/13/2006
Last updated
06/26/2020
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