Healthcare Provider Details

I. General information

NPI: 1104535442
Provider Name (Legal Business Name): MRS. CHEYELLE B DELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 NW 15TH ST APT B110
GRESHAM OR
97030-4961
US

IV. Provider business mailing address

1200 CONCORD AVE STE 100
CONCORD CA
94520-4969
US

V. Phone/Fax

Practice location:
  • Phone: 971-363-7788
  • Fax:
Mailing address:
  • Phone: 510-268-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: