Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | A61619 | CA |
NPI | 1043204605 |
---|---|
Provider Name | Nicolas R Delapena |
First Address | Merced, CA 95340-0964 |
Second Address | Merced, CA 95340-0964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A616191 | (05) | CA |
G01585 | (02) | CA |