Individual provider Active NPI

Darren Dalisay, PTA

  • Physical Therapy Assistant
  • San Diego, CA
National Provider Identifier
1043856917
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA48136 Issued in CA
Practice address
4435 Eastgate Mall Ste 120
San Diego, CA 92121-1980
Phone
(858) 587-8669
NPI assigned
Nov 25, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA48136 CA Primary

Addresses

Primary practice location

4435 Eastgate Mall Ste 120
San Diego, CA 92121-1980

Mailing address

12849 Shady Oak CT
Poway, CA 92064-6053
Phone (619) 913-2048

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA48136CAMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1043856917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12849 SHADY OAK CT",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920646053",
            "telephone_number": "619-913-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 EASTGATE MALL STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211980",
            "telephone_number": "858-587-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALISAY",
        "first_name": "DARREN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "PTA48136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.