Healthcare Provider Details

I. General information

NPI: 1811173891
Provider Name (Legal Business Name): ERIBERTO DEALBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDDIE DEALBA

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 N H ST
LOMPOC CA
93436-4519
US

IV. Provider business mailing address

646 NORTH H ST.
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-1940
  • Fax:
Mailing address:
  • Phone: 805-865-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: