Healthcare Provider Details

I. General information

NPI: 1043478829
Provider Name (Legal Business Name): KEMBERLY DELELLIS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEMBY BACON

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 LINCOLN WAY
AUBURN CA
95603-4807
US

IV. Provider business mailing address

PO BOX 6622
INCLINE VILLAGE NV
89450-6622
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-5908
  • Fax:
Mailing address:
  • Phone: 808-333-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60134126
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-226
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: