Provider Demographics
NPI:1477657989
Name:GOREY, DELIA MARY
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:MARY
Last Name:GOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 TELEGRAPH RD
Mailing Address - Street 2:B1
Mailing Address - City:VERTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-658-7136
Mailing Address - Fax:805-658-7140
Practice Address - Street 1:5550 TELEGRAPH RD
Practice Address - Street 2:B1
Practice Address - City:VERTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-658-7136
Practice Address - Fax:805-658-7140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18596Medicare ID - Type Unspecified