Healthcare Provider Details

I. General information

NPI: 1972407575
Provider Name (Legal Business Name): CORY LEONARD DILELLA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OCEAN FRONT WALK
VENICE CA
90291-2403
US

IV. Provider business mailing address

4842 W 99TH ST
INGLEWOOD CA
90301-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-3070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1445370526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: