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NPI Code Detail

MEDICARE: DELTA CARE, INC.

MEDICARE: DELTA CARE, INC.
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
1251S00000XCommunity/Behavioral Health Agency100082ANCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B5872192OTHERCACA DMV

General Provider Information

NPI Number : 1659622371
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA CARE, INC.
Provider Business Mailing Address
First Line : 4705 N SONORA AVE STE 113
Second Line :
City : FRESNO
State : CA
Zip : 93722-3965
Country : US
Telephone Number : 559-276-7558
Fax Number :
Provider Business Practice Location Address
First Line : 4705 N SONORA AVE STE 113
Second Line :
City : FRESNO
State : CA
Zip : 93722-3965
Country : US
Telephone Number : 559-276-7558
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE PROGRAM COORDINATOR
Name : MS. MINERVA MINNIE MIJANGOS
Credential :
Telephone Number : 559-276-7558
Provider Enumeration Date : 09/20/2012
Last Update Date : 09/20/2012

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Directions to “DELTA CARE, INC. ” Practice Location

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