Provider Demographics
NPI:1922298280
Name:ECLEONEL, DARLENE BACLAGAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:BACLAGAN
Last Name:ECLEONEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DARLENE
Other - Middle Name:GARCIA
Other - Last Name:BACLAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16950 VIA TAZON
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1607
Mailing Address - Country:US
Mailing Address - Phone:858-521-2265
Mailing Address - Fax:858-521-2016
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127
Practice Address - Country:US
Practice Address - Phone:858-521-2265
Practice Address - Fax:858-521-2016
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist