Healthcare Provider Details

I. General information

NPI: 1578603460
Provider Name (Legal Business Name): DANIELLE DELVO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 CREEKSIDE DR
FOLSOM CA
95630-3400
US

IV. Provider business mailing address

2100 POWELL ST STE 920
EMERYVILLE CA
94608-1844
US

V. Phone/Fax

Practice location:
  • Phone: 800-842-2619
  • Fax:
Mailing address:
  • Phone: 800-842-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 17189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: