Provider Demographics
NPI:1164560579
Name:DILES, WILLIAM S
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:DILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MISSION CIR
Mailing Address - Street 2:STE #203
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5369
Mailing Address - Country:US
Mailing Address - Phone:707-538-1000
Mailing Address - Fax:707-538-1013
Practice Address - Street 1:52 MISSION CIR
Practice Address - Street 2:STE #203
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5369
Practice Address - Country:US
Practice Address - Phone:707-538-1000
Practice Address - Fax:707-538-1013
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU973237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAD000150Medicaid
CAHAD000150Medicaid