MEDICARE: GREGORY ALEXANDER MCKINLEY DILTS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1326682113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY ALEXANDER MCKINLEY DILTS MA

Provider Business Mailing Address
First Line	:	3815 MARCONI AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3867
Country	:	US
Telephone Number	:	916-890-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 MARCONI AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3867
Country	:	US
Telephone Number	:	916-890-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	03/16/2026

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