Healthcare Provider Details

I. General information

NPI: 1508889445
Provider Name (Legal Business Name): DEAN C. DELIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V A MEDICAL CTR # 116B 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

V A MEDICAL CTR # 116B 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-921-1900
  • Fax:
Mailing address:
  • Phone: 619-921-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 6971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: