Provider Demographics
NPI:1851156913
Name:DEARMOND, DRETON
Entity Type:Individual
Prefix:
First Name:DRETON
Middle Name:
Last Name:DEARMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 E 4TH ST UNIT 3037
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5063
Mailing Address - Country:US
Mailing Address - Phone:909-631-5217
Mailing Address - Fax:
Practice Address - Street 1:3420 E 4TH ST UNIT 3037
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5063
Practice Address - Country:US
Practice Address - Phone:909-631-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51189225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant