Provider Demographics
NPI:1487003166
Name:INTZES, DELORES
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:INTZES
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 1:333 FOREST WOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-9455
Mailing Address - Country:US
Mailing Address - Phone:352-277-3341
Mailing Address - Fax:352-277-3341
Practice Address - Street 1:333 FOREST WOOD CT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-9455
Practice Address - Country:US
Practice Address - Phone:352-277-3341
Practice Address - Fax:352-277-3341
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker