Healthcare Provider Details

I. General information

NPI: 1205771367
Provider Name (Legal Business Name): DELISA VELEZ THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31913 CALLE EL POTRERO
PAUMA VALLEY CA
92061-9724
US

IV. Provider business mailing address

31913 CALLE EL POTRERO
PAUMA VALLEY CA
92061-9724
US

V. Phone/Fax

Practice location:
  • Phone: 916-289-9904
  • Fax:
Mailing address:
  • Phone: 916-289-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number003200281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: