Provider Demographics
NPI:1801920293
Name:LINENBERGER, DARRICK L
Entity type:Individual
Prefix:MR
First Name:DARRICK
Middle Name:L
Last Name:LINENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DARRICK
Other - Middle Name:L
Other - Last Name:LINENBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,ATC
Mailing Address - Street 1:4109 EL MOLINO BLVD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:645 S BARRANCA ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-2943
Practice Address - Country:US
Practice Address - Phone:626-974-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer