Provider Demographics
NPI:1619098845
Name:RASZL, DARRYL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LEE
Last Name:RASZL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1518
Mailing Address - Country:US
Mailing Address - Phone:415-661-1928
Mailing Address - Fax:415-661-7911
Practice Address - Street 1:14 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1518
Practice Address - Country:US
Practice Address - Phone:415-661-1928
Practice Address - Fax:415-661-7911
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20677207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G206770Medicare ID - Type Unspecified
A41021Medicare UPIN