Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MT191043 | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A121729 | CA |
NPI | 1033371844 |
---|---|
Provider Name | Amy Delaney |
First Address | Riverside, CA 92507-0901 |
Second Address | Riverside, CA 92507-0901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730180415 | GROUP NPI (01) | CA |
1780782557 | SITE NPI (01) | CA |