1346958550 NPI number — DALEY WELLNESS GROUP, PSYCHOLOGICAL & SPIRITUAL HEALTH, P.C.

Table of content: (NPI 1346958550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346958550 NPI number — DALEY WELLNESS GROUP, PSYCHOLOGICAL & SPIRITUAL HEALTH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALEY WELLNESS GROUP, PSYCHOLOGICAL & SPIRITUAL HEALTH, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1346958550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 581905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95358-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 COFFEE RD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95355-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-967-2505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DALEY
Authorized Official First Name:
LUZ MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PSYCHOLOGIST
Authorized Official Telephone Number:
415-967-2505

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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