Healthcare Provider Details

I. General information

NPI: 1760170161
Provider Name (Legal Business Name): ALYSSA DELIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DELL MEDICAL SCHOOL AT UNIVERSITY OF TEXAS, GME OFFICE 1501 RED RIVER, 2ND FLOOR
AUSTIN TX
78712
US

IV. Provider business mailing address

DELL MEDICAL SCHOOL AT UNIVERSITY OF TEXAS, GME OFFICE 1501 RED RIVER, 2ND FLOOR
AUSTIN TX
78712
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5555
  • Fax:
Mailing address:
  • Phone: 512-495-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10083859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: