Healthcare Provider Details

I. General information

NPI: 1104738731
Provider Name (Legal Business Name): KEYLA MARLENE DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5781 36TH ST
JURUPA VALLEY CA
92509-4309
US

IV. Provider business mailing address

5781 36TH ST
JURUPA VALLEY CA
92509-4309
US

V. Phone/Fax

Practice location:
  • Phone: 951-544-6217
  • Fax: 951-544-6217
Mailing address:
  • Phone: 951-544-6217
  • Fax: 951-544-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberU0667108
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: