Provider Demographics
NPI:1023028248
Name:DEL VALLE CLINIC, INC
Entity Type:Organization
Organization Name:DEL VALLE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:OEHRLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:925-443-2500
Mailing Address - Street 1:1797 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4347
Mailing Address - Country:US
Mailing Address - Phone:925-443-2500
Mailing Address - Fax:925-443-0771
Practice Address - Street 1:1797 4TH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4347
Practice Address - Country:US
Practice Address - Phone:925-443-2500
Practice Address - Fax:925-443-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77050ZMedicare Oscar/Certification