Healthcare Provider Details

I. General information

NPI: 1619956380
Provider Name (Legal Business Name): MARIE LOUISE DELL'AQUILA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR UCSD DIVISION OF MEDICAL GENETICS-0639
LA JOLLA CA
92093-0639
US

IV. Provider business mailing address

12306 BRICKELLIA ST
SAN DIEGO CA
92129-4152
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4308
  • Fax: 858-534-0269
Mailing address:
  • Phone: 858-484-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberDRM 022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: