Provider Demographics
NPI:1043558679
Name:DELASALAS, RENEE FRANCINE (DPT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:FRANCINE
Last Name:DELASALAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 G AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1232
Mailing Address - Country:US
Mailing Address - Phone:619-665-5466
Mailing Address - Fax:
Practice Address - Street 1:349 G AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1232
Practice Address - Country:US
Practice Address - Phone:619-665-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist