Healthcare Provider Details

I. General information

NPI: 1023334497
Provider Name (Legal Business Name): MIJA DELANEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIJA DELANEY

II. Dates (important events)

Enumeration Date: 04/10/2010
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6640
  • Fax:
Mailing address:
  • Phone: 408-885-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number666443
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: