Healthcare Provider Details

I. General information

NPI: 1417420860
Provider Name (Legal Business Name): BRITTANI ALEXANDRA DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16365 PICK PL
RIVERSIDE CA
92504-5638
US

IV. Provider business mailing address

16365 PICK PL
RIVERSIDE CA
92504-5638
US

V. Phone/Fax

Practice location:
  • Phone: 909-368-5564
  • Fax:
Mailing address:
  • Phone: 844-762-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: