Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | G47183 | CA |
N | 207RI0200X | Infectious Disease | G47183 | CA |
N | 207RP1001X | Pulmonary Disease | G47183 | CA |
NPI | 1063458495 |
---|---|
Provider Name | Richard David Defelice |
First Address | Sacramento, CA 95825-2296 |
Second Address | Sacramento, CA 95816-6510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G471830 | (05) | CA |
A50616 | (02) | CA |