Provider Demographics
NPI:1295565992
Name:DUBOSE, DARCI (DPT)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:DUBOSE
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 1:12120 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-1104
Mailing Address - Country:US
Mailing Address - Phone:619-504-1729
Mailing Address - Fax:
Practice Address - Street 1:5555 RESERVOIR DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5194
Practice Address - Country:US
Practice Address - Phone:858-457-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist