Healthcare Provider Details

I. General information

NPI: 1477479228
Provider Name (Legal Business Name): HALEY ANN DELOACH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 GOVERNOR DR STE A
SAN DIEGO CA
92122-2520
US

IV. Provider business mailing address

4135 PARK BLVD UNIT 724
SAN DIEGO CA
92103-2699
US

V. Phone/Fax

Practice location:
  • Phone: 858-358-5801
  • Fax:
Mailing address:
  • Phone: 615-519-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: