Provider Demographics
NPI:1790267631
Name:CHING, DARA MARIA (DPT)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MARIA
Last Name:CHING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6679 CORTE MARIA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5916
Mailing Address - Country:US
Mailing Address - Phone:808-222-7509
Mailing Address - Fax:
Practice Address - Street 1:4435 EASTGATE MALL STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1980
Practice Address - Country:US
Practice Address - Phone:858-587-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist