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General NPI Number Information
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NPI Number | 1912166786
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Entity Type | Individual
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Provider Name | KEMESHA DELISSER MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 480 DEL NORTE AVE
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City | YUBA CITY
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State | CA
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Zip | 95991-4125
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Country | US
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Telephone | 916-953-7571
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Fax | 916-771-8515
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Provider Business Mailing Address
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Address Line | 729 SUNRISE AVE STE 602
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City | ROSEVILLE
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State | CA
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Zip | 95661-4542
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Country | US
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Telephone | 916-953-7571
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Fax | 916-771-8515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101252058
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 0101252058
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD60960761
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD60960761
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License Number State | WA
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