Provider Demographics
NPI:1740463165
Name:WILKINS, DARRELL TIMOTHY (PA)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:TIMOTHY
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3330
Mailing Address - Country:US
Mailing Address - Phone:951-735-6060
Mailing Address - Fax:951-735-4510
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3330
Practice Address - Country:US
Practice Address - Phone:951-735-6060
Practice Address - Fax:951-735-4510
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16458363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMW0880535OtherDEA