Healthcare Provider Details

I. General information

NPI: 1497071443
Provider Name (Legal Business Name): MARIA REGINA ABESA DELOZIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA REGINA ARAYATA ABESA

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 CONVOY CT DEPT OF
SAN DIEGO CA
92111-1014
US

IV. Provider business mailing address

393 E WALNUT ST
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5000
  • Fax:
Mailing address:
  • Phone: 619-464-6434
  • Fax: 619-464-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA124305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: