Healthcare Provider Details

I. General information

NPI: 1467782102
Provider Name (Legal Business Name): DELTA CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 N SONORA AVE SUITE 113
FRESNO CA
93722-3966
US

IV. Provider business mailing address

4705 N SONORA AVE STE 113
FRESNO CA
93722-3965
US

V. Phone/Fax

Practice location:
  • Phone: 559-276-7558
  • Fax: 559-276-7568
Mailing address:
  • Phone: 559-276-7558
  • Fax: 559-276-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100082AN
License Number StateCA

VIII. Authorized Official

Name: MRS. RITA OBIAJULUM ENUNWA
Title or Position: EXECUTIVE DIRECTOR
Credential: MSN, FNP-C
Phone: 559-276-7558