MEDICARE: MRS. DANA DELVALLE RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1427817196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA DELVALLE RDH

Provider Business Mailing Address
First Line	:	1253 DARWIN ST
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-5601
Country	:	US
Telephone Number	:	907-687-0286
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 FOREST AVE STE G
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-5136
Country	:	US
Telephone Number	:	907-687-0286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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