Healthcare Provider Details

I. General information

NPI: 1902003148
Provider Name (Legal Business Name): DELTA ELAINE DUVALI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

17415 GRAYSTONE AVE
CERRITOS CA
90703-5505
US

V. Phone/Fax

Practice location:
  • Phone: 626-851-7039
  • Fax:
Mailing address:
  • Phone: 562-706-1032
  • Fax: 626-851-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: