Provider Demographics
NPI:1649603804
Name:PICRAUX, DARYL SAMANTHA (MS)
Entity type:Individual
Prefix:MRS
First Name:DARYL
Middle Name:SAMANTHA
Last Name:PICRAUX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VIA BONITA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-4926
Mailing Address - Country:US
Mailing Address - Phone:505-235-8261
Mailing Address - Fax:
Practice Address - Street 1:4000 14TH ST STE 502
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4019
Practice Address - Country:US
Practice Address - Phone:951-683-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS