Healthcare Provider Details

I. General information

NPI: 1114891058
Provider Name (Legal Business Name): DELILAH JEANETTE OLVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 CAMINO DEL RIO N STE 104
SAN DIEGO CA
92108-1738
US

IV. Provider business mailing address

3550 CAMINO DEL RIO N STE 104
SAN DIEGO CA
92108-1738
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-1125
  • Fax:
Mailing address:
  • Phone: 760-634-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: