Healthcare Provider Details

I. General information

NPI: 1699226134
Provider Name (Legal Business Name): CARA ANN DELVECCHIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 08/10/2023
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W HILLCREST DR
THOUSAND OAKS CA
91320-2734
US

IV. Provider business mailing address

1200 W HILLCREST DR
THOUSAND OAKS CA
91320-2734
US

V. Phone/Fax

Practice location:
  • Phone: 888-898-3806
  • Fax:
Mailing address:
  • Phone: 888-898-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6790
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95018653
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6790
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number6790
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95018653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: