Healthcare Provider Details

I. General information

NPI: 1265606909
Provider Name (Legal Business Name): MARY DELISLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 HARRISON RD
SALINAS CA
93907-1660
US

IV. Provider business mailing address

PO BOX 730276
SAN JOSE CA
95173-0276
US

V. Phone/Fax

Practice location:
  • Phone: 831-443-5225
  • Fax:
Mailing address:
  • Phone: 408-971-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW16880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: