Healthcare Provider Details

I. General information

NPI: 1225829682
Provider Name (Legal Business Name): KAITLYN DANIELLE DELGADILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W SHAW LN STE 104
FRESNO CA
93711-2777
US

IV. Provider business mailing address

2560 W SHAW LN STE 104
FRESNO CA
93711-2777
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4800
  • Fax:
Mailing address:
  • Phone: 559-443-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ADZEPO
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: