Healthcare Provider Details

I. General information

NPI: 1992611792
Provider Name (Legal Business Name): DELILA RAE WADE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 MURPHY CANYON RD STE 110
SAN DIEGO CA
92123-4411
US

IV. Provider business mailing address

10031 W MONTECITO AVE
PHOENIX AZ
85037-5614
US

V. Phone/Fax

Practice location:
  • Phone: 619-577-4074
  • Fax:
Mailing address:
  • Phone: 623-256-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number335809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: