=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346958550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DALEY WELLNESS GROUP, PSYCHOLOGICAL & SPIRITUAL HEALTH, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 11/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 COFFEE RD STE A1
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-967-2505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 581905
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95358-0033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. LUZ MARIA DALEY
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 415-967-2505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------